Provider Demographics
NPI:1912883042
Name:KELLY, CAROLINE LEE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MINE ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870-1340
Mailing Address - Country:US
Mailing Address - Phone:906-970-9059
Mailing Address - Fax:
Practice Address - Street 1:306 MINE ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-1340
Practice Address - Country:US
Practice Address - Phone:906-970-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula