MRS. KELLY RENET DALE (P.A.) – Medical Physician Assistant, NPI 1952468530
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,069 PHYSICIAN ASSISTANT in MI
Provider Addresses for MRS. KELLY RENET DALE (P.A.)
150 Plymouth Rd
Saginaw, MI 486387135
Phone: (989) 323-3863
Fax: (989) 502-1122
Type: Location
PO BOX 610669
PORT HURON, MI 480610669
Phone: (810) 216-1496
Fax: (810) 216-3025
Type: Mailing
3111, Electric Avenue, Grand Trunk Business Park, Port Huron, Saint Clair County, Michigan, 48060, United States
PORT HURON, MI 480608127
Phone: (810) 985-4747
Fax: (810) 985-5579
Type: Location
154 S Main St Ste 6
Frankenmuth, MI 487341692
Phone: (989) 502-1122
Fax: (989) 502-1212
Type: Location
2690 GERMANIA RD
MARLETTE, MI 484538965
Phone: (810) 577-7395
Type: Mailing
416 WOODLAND DR
SANDUSKY, MI 484711047
Phone: (810) 202-6022
Fax: (810) 682-4026
Type: Location
154 S MAIN ST STE 6
FRANKENMUTH, MI 487341692
Phone: (989) 502-1122
Fax: (989) 502-1212
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-06-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050614001288 | I | Physician Assistant | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48638)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MI | |
| Physician Assistant | MI |
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