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KELLEY PARK
NPI 1265067318
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since March 10, 2020PECOS Enrolled
540 E CANFIELD ST, DETROIT, MI 48201(313) 577-1466 Get Directions Write a Review

NPPES record last updated: March 10, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelley Park NPPES

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

KELLEY PARK (NPI 1265067318) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1265067318
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKELLEY PARK
Location Address540 E CANFIELD STDetroit, MI 48201-1928
Mailing Address540 E Canfield StDetroit, MI 48201-1928
Phone(313) 577-1466
Sole ProprietorNo
Enumeration DateMarch 10, 2020
NPPES CertifiedMarch 10, 2020
✔ NPI 1265067318 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
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.
540 E CANFIELD ST, Detroit, MI 48201
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelley Park 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.

ISAAC AARON GOLDBERG
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1470
SEBASTIAN DUNCAN
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1466
KAILEY OPPAT
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1466
SHIVANI BONGU MD
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1466
BENJAMIN MORIN SIMS
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1463
NEETI GANDRA
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (313) 577-1466
HALAH ZOHRA KERAMANE
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (678) 327-7573
ALEXA KALAJ
Student in an Organized Health Care Education/Training Program
540 E CANFIELD ST
DETROIT, MI 48201
Wayne County (248) 515-5502

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 Kelley Park's NPI number?

The NPI number for Kelley Park is 1265067318. It was assigned to this individual provider in the NPPES registry on March 10, 2020.

Where is Kelley Park located?

Kelley Park practices at 540 E Canfield St, Detroit, MI 48201. The listed phone number is (313) 577-1466.

What is Kelley Park's specialty?

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

Is Kelley Park enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Kelley Park was last updated on March 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.