Theresa Kelly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006213 Issued in MI

Practice address

30472 23 Mile Rd
Chesterfield, MI 48047-1844

Phone

(586) 863-4000

Fax

(586) 863-4004

NPI assigned

Jan 13, 2012

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hetal Patel, M.D. P.C.

  • Psychiatry Physician
  • Chesterfield, MI
  • NPI 1447672944
  NPD (past)

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

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788652800000",
    "number": "1679844104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30472 23 MILE RD",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480471844",
            "telephone_number": "586-863-4000",
            "fax_number": "586-863-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30472 23 MILE RD",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480471844",
            "telephone_number": "586-863-4000",
            "fax_number": "586-863-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THERESA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-13",
        "last_updated": "2026-09-06",
        "certification_date": "2026-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5601006213",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohammed Kawar
• Sarah Keller
• Kania Kelley
• Angel Kelly
• Jenelle Kelly
• Moniqua Kemp
• Kaitlyn Kenel
• Kayla Elizabeth Kent, PA-C, AT, ATC
• Madison Grace Kent
• Kenwood Allergy & Asthma Center, P.C.

• Physician Assistant in Chesterfield, MI
• Providers in Chesterfield, 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 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.