Provider Demographics
NPI:1871067819
Name:DRUDY, KELSI E (PA-C)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:E
Last Name:DRUDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-1722
Mailing Address - Country:US
Mailing Address - Phone:517-902-5502
Mailing Address - Fax:
Practice Address - Street 1:1277 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-4605
Practice Address - Country:US
Practice Address - Phone:231-672-6186
Practice Address - Fax:231-672-6181
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009008363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant