Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelli Moore

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1699243204

Kelli Moore is a Physician Assistant in Bingham Farms, Michigan. Qualified in 2019, 7 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

32270 Telegraph Rd Ste 110
Bingham Farms, MI 48025-2456
Phone: (248) 792-9496
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9103 Country View Dr, Ypsilanti, MI 48197-6650 — (502) 649-2954

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601009656 (MI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1699243204
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 13, 2018
Last updated in NPPESAugust 16, 2020
Certification dateAugust 16, 2020
Mailing address9103 Country View Dr, Ypsilanti, MI 48197-6650

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Bingham Farms