MS. KELLI RENEE ROE P.A.-C NPI 1225318751

NPI Information

NPI: 1225318751
Provider Name: MS. KELLI RENEE ROE, P.A.-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Address:
1634 GULL RD
KALAMAZOO, MI
ZIP 49048
Phone: (269) 903-2835
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MS. Kelli Renee Roe, P.A.-C is a surgical physician assistant in Kalamazoo, MI. MS. Kelli Renee Roe, P.A.-C NPI is 1225318751. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1634 GULL RD
KALAMAZOO, MI
ZIP 49048-632
Phone: (269) 903-2835

The enumeration date for this NPI number is 8/29/2011 and was last updated on 3/2/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	5601006123	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1417961137	OTHER	MICHIGAN	BCBSM - BMH
2	C97618376 - BMH	MEDICARE PIN	MICHIGAN
3	1225318751	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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