Provider Demographics
NPI:1386329381
Name:HOULIHAN, KELLY JAMES (NP)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JAMES
Last Name:HOULIHAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2426 HOUGHTON HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-8420
Mailing Address - Country:US
Mailing Address - Phone:517-575-7338
Mailing Address - Fax:
Practice Address - Street 1:2426 HOUGHTON HOLLOW DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-8420
Practice Address - Country:US
Practice Address - Phone:517-575-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270432NSA2304J363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care