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

Mrs. Kelcie Ann Waack, FNP

Individual provider Internal Medicine Physician · NPI 1730762246

Mrs. Kelcie Ann Waack, FNP is a Nurse Practitioner in Southgate, Michigan. Qualified in 2020, 6 years ago. Practices with Southgate Medical Group PLLC, a 2-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
6
Licensed in
MI
In the registry since
2021
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

3 Heritage Ctr
Southgate, MI 48195
Phone: (734) 283-3222
Fax: (734) 283-4006
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 4704333571 (MI)

Record details

NPI number1730762246
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedMay 3, 2021
Last updated in NPPESDecember 8, 2023
Certification dateDecember 8, 2023

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Southgate Medical Group Pllc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Southgate