Active NPI
Kelly Mitchell
- Contractor
- Tustin, MI
National Provider Identifier
1891064085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- AF670015175
- Practice address
- 15194 21 Mile Rd
Tustin, MI 49688-8545 - Phone
- (231) 829-3098
- NPI assigned
- Dec 19, 2011
- Last updated
- Dec 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | AF670015175 | MI | Primary |
Addresses
Primary practice location
15194 21 Mile Rd
Tustin, MI 49688-8545
Mailing address
15194 21 Mile Rd
Tustin, MI 49688-8545
Phone (231) 829-3098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AF670015175 | MI | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1891064085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15194 21 MILE RD",
"city": "TUSTIN",
"state": "MI",
"postal_code": "496888545",
"telephone_number": "231-829-3098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15194 21 MILE RD",
"city": "TUSTIN",
"state": "MI",
"postal_code": "496888545",
"telephone_number": "231-829-3098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MI",
"license": "AF670015175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, MI
- Sheree L Engler, RN
- Bridget Renee Johnson
- Abhishek Kelkar
- Mecosta County Medical Center (Spectrum Health Big Rapids Hospital Family Medicine Tustin)
- Holli Michelle Meier, MA, CCC-SLP
- Ronald W Moesta, MSW
- Amanda Nixon
- Patricia Puglia
- Reed City Hospital Corporation (Spectrum Health Reed City Hospital Tustin Family Practice)
- Katherine Reynhout
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.