NPI 1003217860

Kelly Malia Peterson, PAC

Practitioner Physician Assistant Muskegon, MI

Practice location

Address: 1301 Mercy Drive, Muskegon, MI 49444
Phone: (231) 739-9492
Mailing address: 3621 S State St, Ann Arbor, MI 48108-1633

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601007197 (MI)

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Registry record

NPI: 1003217860
Entity type: Individual
Sex (as registered): Female
NPI issued: 11 Sep 2014
Record last updated: 5 Aug 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.