Kelly M Coleman, NP
Individual provider Active NPI Nurse Practitioner · Walker, MI
NPI 1831133016 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1831133016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 4704243275 (MI)
- Practice address
- 933 3 Mile Rd NW Ste 210
Walker, MI 49544-1673 - Phone
- (616) 685-8150
- Fax
- (616) 785-0238
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advantage Health/Saint Mary'S Medical Group
Practice addresses (Care Compare)
10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850
933 3 Mile Rd NW
Suite 210
Grand Rapids, MI 49544-1673
Phone (616) 685-8150
Hospital & facility affiliations
- Mercy Health Saint Mary'S
- Trinity Health Muskegon Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060202000254 | MI | Practitioner - Nurse Practitioner | 4981618691 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704243275 | MI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Health Saint Mary'S Medical Group | Nurse Practitioner | Current |
Accepting new patients |
| Advantage Health/Saint Mary'S Medical Group | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Past | Accepting new patients |
Locations
10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850
933 3 Mile Rd NW
Ste 210
Walker, MI 49544
Phone (616) 685-7985
Interoperability endpoints
- kcoleman44412@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704243275 | MI | Yes |
Addresses
Primary practice location
933 3 Mile Rd NW Ste 210
Walker, MI 49544-1673
Mailing address
2332 Knapp Forest CT NE
Grand Rapids, MI 49525-9750
Phone (812) 459-7649
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4837100 | Medicaid | MI |
Other providers in Walker, MI
- Carlee Campbell
- Jayma Corinne Carney
- Melissa Chesnut
- Belinda Chou
- Michael Scott Christy Jr.
- Ashley Lynn Conner
- Erica Curtis
- David C. Gruber, DDS, Ms, PC
- Rylee Davis
- Cassie Deising
All providers in Walker, MI · Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.