Provider Demographics
NPI:1194502724
Name:MARION, KELSEY LEIGH (RN, BSN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGH
Last Name:MARION
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEIGH
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:255 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265-9580
Mailing Address - Country:US
Mailing Address - Phone:517-260-8672
Mailing Address - Fax:
Practice Address - Street 1:255 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9580
Practice Address - Country:US
Practice Address - Phone:517-260-8672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315110364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult