Provider Demographics
NPI:1447536479
Name:KILBREATH, KELLY A (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:KILBREATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 E COOK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8368
Mailing Address - Country:US
Mailing Address - Phone:810-922-0806
Mailing Address - Fax:810-639-3167
Practice Address - Street 1:190 E STATE ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9144
Practice Address - Country:US
Practice Address - Phone:810-639-2056
Practice Address - Fax:810-639-3167
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily