KELLIE LEA MUMFORD (NPI# 1346496759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346496759 |
| Entity Type | Individual |
| Full Name | KELLIE LEA MUMFORD |
| Credential | PA-C |
| Practice Address |
2147 Professional Dr Gaylord MI 49735-0003 |
| Mailing Address |
829 N Center Ave Suite 298 Gaylord MI 49735-1595 |
| Practice Telephone | 9897321753 |
| Practice Fax Number | 9897311425 |
| Mailing Telephone | 9897317708 |
| Mailing Fax Number | 9897317929 |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2013-12-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601005363 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE GROUP NUMBER | OF96004 | 01 |
| Street Address |
2147 PROFESSIONAL DR |
| City | GAYLORD |
| State | MI |
| Zip Code | 49735-0003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508867490 | Gilbert Alan Noirot | Orthopaedic Surgery | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2005-08-02 |
| 1689176224 | Brittany Janel Beyers | Physical Therapist | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2018-02-28 |
| 1205189669 | Adrienne Margaret Kelly | Orthopaedic Surgery | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2012-10-23 |
| 1881811891 | Niki L Diehl | Physical Therapist | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2007-04-19 |
| 1003823246 | Patrick Allan Cosgrove | Physical Therapist | 2147 Professional Dr, Suite 2, Gaylord, MI 49735 | 2006-08-01 |
| 1821038217 | Shannon C Gabel Dorr | Physician Assistant | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2006-06-07 |
| 1427033976 | Louis S Habryl | Orthopaedic Surgery | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2005-12-07 |
| 1750366217 | N'orthopedics PC | Orthopaedic Surgery | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2005-12-07 |
| 1770568248 | Shelly R Slivinski | Physician Assistant | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2005-12-07 |
| 1548245095 | Robert L Halter | Orthopaedic Surgery | 2147 Professional Dr, Gaylord, MI 49735-0003 | 2005-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447453 | Jenni Kirt | Social Worker | 407 I-75 Bus N, Gaylord, MI 49735 | 2020-11-05 |
| 1922584986 | Patricia Dovalina | Behavior Technician | 2285 Michaywe Dr, Otsego Lake, MI 49735 | 2018-07-12 |
| 1265944581 | James Hulbert | Social Worker | 407 W Main Street, Gaylord, MI 49735 | 2017-10-26 |
| 1548792625 | Somer Lawes | Behavior Technician | 2443 Castlewood Dr, Gaylord, MI 49735 | 2017-03-29 |
| 1922554161 | Mark David Mcpherson | Counselor | 2136 West M-32, Gaylord, MI 49735 | 2016-08-28 |
| 1689063034 | Liza Brandt | Behavioral Analyst | 6748 Colonial Ct, Gaylord, MI 49735 | 2015-01-22 |
| 1942597224 | Visions for Your Community Care Hhc | Home Health | 2365 N Perch Lake Dr, Gaylord, MI 49735 | 2011-07-07 |
| 1073778304 | Julie Lynn Vandusen | Community Health Worker | 5512 Clubhouse Trail, Gaylord, MI 49735 | 2008-07-25 |
| 1073708798 | Alpine Chiropractic, PC | Chiropractor | 529 S. Wisconsin Ave, Gaylord, MI 49735 | 2007-09-06 |
| 1669675567 | Oral and Maxillofacial Surgery Associates | Dentist | 785 E M32, Gaylord, MI 49735 | 2007-06-07 |
| Find all providers in zip 49735 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629005111 | Renee Deanne Mesack | Physician Assistant | 1996 Walden Dr, Gaylord, MI 49735-8241 | 2006-06-28 |
| 1528028206 | James A Swartz | Physician Assistant | 806 S Otsego Ave, Gaylord, MI 49735-1725 | 2006-03-25 |
| 1114303575 | Brittanie Hamlin | Physician Assistant | 829 N Center Ave, Gaylord, MI 49735-1595 | 2015-08-07 |
| 1770973166 | Jeffery Robert Wohlfeil | Physician Assistant | 652 N Otsego Ave, Gaylord, MI 49735-2502 | 2015-01-23 |
| 1124370325 | Christopher David Blanchet | Physician Assistant | 994 N Center Ave, Gaylord, MI 49735-9375 | 2012-10-11 |
| 1235401712 | John Matthew Lawrence | Physician Assistant | 829 N Center Ave, Suite 210, Gaylord, MI 49735-1595 | 2012-01-31 |
| 1598073801 | Shawn M Bahleda | Physician Assistant | 829 N Center Ave, Gaylord, MI 49735-1595 | 2010-09-21 |
| 1639301724 | Ronald Frank Applebey | Physician Assistant | 829 N Center Ave, Suite 210, Gaylord, MI 49735-1595 | 2009-08-22 |
| 1447468442 | Munson Healthcare Otsego Memorial Hospital | Physician Assistant | 825 N Center Ave, Gaylord, MI 49735 | 2007-05-21 |
| 1386744423 | Wayne C Aldrich | Physician Assistant | 829 N Center Ave, Gaylord, MI 49735-1595 | 2006-09-25 |
| Find all providers in GAYLORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.