KELLI BEAUDOIN (NPI# 1891725495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891725495 |
| Entity Type | Individual |
| Full Name | KELLI BEAUDOIN |
| Other Name | KELLI CRAWFORD |
| Credential | PA |
| Practice Address |
18100 Oakwood Blvd Suite 300 Dearborn MI 48124-4085 |
| Mailing Address |
21031 Michigan Ave Suite 400-credentialing Dearborn MI 48124-2339 |
| Practice Telephone | 3134297977 |
| Practice Fax Number | 3134297981 |
| Mailing Telephone | 3132776700 |
| Mailing Fax Number | 3132160176 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2017-01-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601003485 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5601003485 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
18100 OAKWOOD BLVD SUITE 300 |
| City | DEARBORN |
| State | MI |
| Zip Code | 48124-4085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578535142 | Lawrence G Morawa | Orthopaedic Surgery | 18100 Oakwood Blvd, 300, Dearborn, MI 48124-4085 | 2006-02-07 |
| 1992110522 | Michelle T Leonard | Psychologist | 18100 Oakwood Blvd, C/o Michelle Leonard, Dearborn, MI 48124-4085 | 2014-06-23 |
| 1801215959 | Lassen Dialysis LLC | Clinic/Center | 18100 Oakwood Blvd, Ste 206, Dearborn, MI 48124-4085 | 2014-04-15 |
| 1851630206 | University Physician Group | Occupational Therapist | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4085 | 2013-02-05 |
| 1992044598 | University Physician Group | Prosthetic/Orthotic Supplier | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4085 | 2013-02-04 |
| 1073878682 | Tiona Kimisha Stephens | Internal Medicine | 18100 Oakwood Blvd, Site 01 Medical Education, Dearborn, MI 48124-4085 | 2012-07-10 |
| 1598052441 | Geoffrey Alan Potts | Dermatology | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4085 | 2011-06-29 |
| 1346565355 | Mariana Dimovski Atanasovski | Dermatology | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4089 | 2010-04-01 |
| 1821310806 | Oakwood Healthcare Inc | Clinic/Center | 18100 Oakwood Blvd, Suite 206, Dearborn, MI 48124-4085 | 2010-02-18 |
| 1114257540 | Dynamic Urocare PC | Urology | 18100 Oakwood Blvd, Ste 315, Dearborn, MI 48124-4085 | 2010-01-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396389524 | Pharma A, LLC | Pharmacy | 23916 Michigan Ave, Dearborn, MI 48124 | 2019-10-31 |
| 1225683725 | Aysha Said | Behavior Technician | 1369 Porter St, Dearborn, MI 48124 | 2019-08-02 |
| 1881257772 | Leen Nusairat | Internal Medicine | Beaumont Health-dearborn Campus, 18101 Oakwood Blvd, Dearborn, MI 48124 | 2019-04-17 |
| 1417413360 | Gary C. Veraghen, Dds, PC | Dentist | 22100 W. Outer Drive, Dearborn, MI 48124 | 2019-02-15 |
| 1982168787 | Fnu Asma Manzar | Physical Therapist | Global Physical Therapy Services, Inc, 22819 Michigan Avenue, Dearborn, MI 48124 | 2019-01-25 |
| 1639640162 | Jernia Lashawn Usher | Behavior Technician | 1360 Porter St Lower Level, Dearborn, MI 48124 | 2018-12-10 |
| 1710456470 | Samar Fouad Hannawi | Psychologist | 3815 Pelham Street, Suite #13, Dearborn, MI 48124 | 2018-11-24 |
| 1881178747 | Sarah Chehab | Psychologist | 835 Mason St Suite 220b, Dearborn, MI 48124 | 2018-09-17 |
| 1568948289 | Ibrahim M Basma | Pharmacist | 22521 Michigan Avenue, Dearborn, MI 48124 | 2018-07-16 |
| 1669961942 | Jacqueline E Domzalski | Technician, Other | 3231 S. Gulley, Suite E, Dearborn, MI 48124 | 2018-05-02 |
| Find all providers in zip 48124 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326664194 | Ibrahim Humaisan | Physician Assistant | 1769 Walnut St, Dearborn, MI 48124-4025 | 2020-06-17 |
| 1518514900 | Afrah Saadi | Physician Assistant | 3375 Hollywood St, Dearborn, MI 48124-4360 | 2019-08-21 |
| 1801352067 | Stacey Marie Stewart | Physician Assistant | 3021 Grindley Park St, Dearborn, MI 48124-4522 | 2019-02-13 |
| 1407206105 | Ayah Jaafar | Physician Assistant | 15120 Prospect St, Dearborn, MI 48126-2922 | 2016-06-14 |
| 1174970693 | Jaber Mawiri | Physician Assistant | 5402 Bingham St, Dearborn, MI 48126-3306 | 2016-05-16 |
| 1699134080 | Mohamad Nehme | Physician Assistant | 5200 Orchard Ave, Dearborn, MI 48126-4620 | 2016-02-15 |
| 1578948220 | Eaman Alhaider | Physician Assistant | 3053 Lindenwood Dr, Dearborn, MI 48120-1311 | 2015-07-23 |
| 1922384064 | Cynthia Kler Rockwell | Physician Assistant | 330 Town Center Dr, Dearborn, MI 48126-2738 | 2011-11-02 |
| 1083902217 | Lena Sarsam | Physician Assistant | 10306 Dix Ave., Dearborn, MI 48120 | 2011-07-21 |
| 1356656706 | Lisa Reuter | Physician Assistant | 2040 Monroe St Ste 207, Dearborn, MI 48124-2950 | 2010-08-10 |
| Find all providers in DEARBORN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.