Boardman Health and Wellness, PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003799 Issued in MI

Legal business name

BOARDMAN HEALTH AND WELLNESS, PLLC

Practice address

4713 Pine St SW
S Boardman, MI 49680-9761

Phone

(231) 369-2656

NPI assigned

Jun 9, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Keane Stetler, PA-CNPI 1164531794

Title

Officer

Phone

(231) 369-2656

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Keane Stetler, PA-C

  • Physician Assistant
  • S Boardman, MI
  • NPI 1164531794
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1063453363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "S BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "S BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARDMAN HEALTH AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "STETLER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "KEANE",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "231-369-2656",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301069428",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Keane Stetler, PA-C

• Physician Assistant in S Boardman, MI
• Providers in S Boardman, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.