Kristen Nicole Gilley, PA-C
Physician Assistant in Lake Odessa, MI. Individual provider (NPI-1).
NPI number1760124176
StatusActive
Last updated in NPPESOct 10, 2022
Details
- NPI
- 1760124176
- Entity type
- Individual (NPI-1)
- Name
- Ms. Kristen Nicole Gilley
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 7, 2022
- Certification date
- Oct 10, 2022
- Last updated
- Oct 10, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601010969 | MI | Yes |
Other names
- Kristen Nicole Cody (Former Name)
Practice location
4294 Laurel DrLake Odessa, MI 48849-8430
Phone 616-374-7660
Mailing address
100 Michigan St Ne # Mc845Grand Rapids, MI 49503-2560
Phone 616-486-6790
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