Individual provider Active NPI

Lyndsey Kelly

  • Nurse Practitioner
  • Waterford, MI
National Provider Identifier
1962373993
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704356731 Issued in MI
Practice address
4568 W Walton Blvd Ste D
Waterford, MI 48329-4900
Phone
(855) 466-3631
Fax
(833) 973-4493
NPI assigned
Sep 15, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704356731 MI Primary

Addresses

Primary practice location

4568 W Walton Blvd Ste D
Waterford, MI 48329-4900

Mailing address

4568 W Walton Blvd Ste D
Waterford, MI 48329-4900
Phone (855) 466-3631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251230003108 MI Practitioner - Nurse Practitioner 1355837253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Transitional Care Services LLCGroup PAC ID 6709165954, 45 clinicians

Practice addresses (Care Compare)

4568 W Walton Blvd
Suite D
Waterford, MI 48329-4900
Phone (855) 466-3631

Hospital & facility affiliations

  • Mary Free Bed at Home, LLC Home health agency, Grand Rapids, MI, CCN 237203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704356731MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Transitional Care Services, LLC CurrentSince Nov 3, 2025 Accepting new patients

Locations

4568 W Walton Blvd
Ste D
Waterford Township, MI 48329
Phone (855) 466-3631

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1757894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1962373993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4568 W WALTON BLVD STE D",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483294900",
            "telephone_number": "855-466-3631",
            "fax_number": "833-973-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4568 W WALTON BLVD STE D",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483294900",
            "telephone_number": "855-466-3631",
            "fax_number": "833-973-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LYNDSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-15",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704356731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.