Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelly Malia Peterson, PA-C

Individual provider Physician Assistant · NPI 1003217860

Kelly Malia Peterson, PA-C is a Physician Assistant in Muskegon, Michigan. Qualified in 2014, 12 years ago. Practices with Lake Michigan Observation Services PLLC, a 32-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
12
Licensed in
MI
In the registry since
2014
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1301 Mercy Dr
Muskegon, MI 49444
Phone: (231) 739-9492
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601007197 (MI)

Record details

NPI number1003217860
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 11, 2014
Last updated in NPPESAugust 5, 2019

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Lake Michigan Observation Services Pllc — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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