Individual
MARK DONALD KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-0001
(616) 975-1845
(616) 975-1870
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704173671
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00725240
RAILROAD MEDICARE
MI
Enumeration date
06/09/2006
Last updated
12/10/2013
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