Kelly Page, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703120562 Issued in MI

Practice address

19611 E 8 Mile Rd
Saint Clair Shores, MI 48080-1655

Phone

(586) 541-9550

NPI assigned

Apr 14, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Woodworth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1548055098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19611 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801655",
            "telephone_number": "586-541-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19611 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801655",
            "telephone_number": "586-541-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGE",
        "first_name": "KELLY",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-14",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703120562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "WOODWORTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Outpatient Endoscopy & Surgi Center
• Outpatient Endoscopy & Surgi Center
• Kayla Pacic, MA
• Paul Padesky, M.D.
• Katie Alyssa Padula, M.A
• Dana Marie Paglia-King
• Brynn M Pajtas, D.D.S., M.S.
• Alexxa Palazzolo, MOTRL
• Rebecca L Palen, LMSW
• Anthony Daniel Palm

• Licensed Practical Nurse in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.