Basic Information
Provider Information
NPI: 1003150392
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOPE
FirstName: KELLY
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: RN, NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29922 MONTMORENCY DR
Address2:  
City: NOVI
State: MI
PostalCode: 483772152
CountryCode: US
TelephoneNumber: 2489601531
FaxNumber:  
Practice Location
Address1: 3601 W 13 MILE RD
Address2:  
City: ROYAL OAK
State: MI
PostalCode: 480736712
CountryCode: US
TelephoneNumber: 2488985000
FaxNumber: 2488981473
Other Information
ProviderEnumerationDate: 11/27/2012
LastUpdateDate: 03/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X4704264482MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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