1. Home
  2. Directory
  3. Michigan
  4. Ann Arbor
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

MACKENZIE KELLEY
NPI 1053258855
Student in an Organized Health Care Education/Training Program in Ann Arbor, MI

Active since April 30, 2026PECOS Enrolled
4260 PLYMOUTH RD, ANN ARBOR, MI 48109(734) 647-5670 Get Directions Write a Review

NPPES record last updated: April 30, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mackenzie Kelley NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MACKENZIE KELLEY (NPI 1053258855) is an individual student in an organized health care education/training program in Ann Arbor, Michigan, licensed in Michigan (4351055751) and active in the NPI registry since April 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053258855
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameMACKENZIE KELLEY
Location Address4260 PLYMOUTH RDAnn Arbor, MI 48109-2700
Mailing Address1500 E Medical Center DrAnn Arbor, MI 48109-5000
Phone(734) 647-5670
Sole ProprietorNo
Enumeration DateApril 30, 2026
NPPES CertifiedApril 30, 2026
✔ NPI 1053258855 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in MI · 4351055751
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4260 PLYMOUTH RD, Ann Arbor, MI 48109
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mackenzie Kelley is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NINA K BIBICOFF NP
Nurse Practitioner
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 764-6831
KATHERINE SABER SALISBURY MD
Internal Medicine (Geriatric Medicine)
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 764-6831
ERIN KHANG LMSW
Social Worker (Clinical)
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 647-5655
REGENTS OF THE UNIVERSITY OF MICHIGAN
Audiologist
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 647-6591
MRS. MARIAM HASSAN REDA MD
Student in an Organized Health Care Education/Training Program
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 647-5680
VIKRAM GOVINDARAJU SHAKKOTTAI M.D.
Psychiatry & Neurology (Neurology)
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 764-6831
JENNY N HSU MD
Internal Medicine
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 647-5650
MRS. SARAH REPP PETERSON A.N.P.
Nurse Practitioner
4260 PLYMOUTH RD
ANN ARBOR, MI 48109
Washtenaw County (734) 763-6295

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mackenzie Kelley's NPI number?

The NPI number for Mackenzie Kelley is 1053258855. It was assigned to this individual provider in the NPPES registry on April 30, 2026.

Where is Mackenzie Kelley located?

Mackenzie Kelley practices at 4260 Plymouth Rd, Ann Arbor, MI 48109. The listed phone number is (734) 647-5670.

What is Mackenzie Kelley's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mackenzie Kelley enrolled in Medicare?

Yes. Mackenzie Kelley is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mackenzie Kelley was last updated on April 30, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.