Healthcare Provider Details

I. General information

NPI: 1356692156
Provider Name (Legal Business Name): KYLA GERMAINE BEAUVAIS NEWMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 JACKSON RD STE 230
ANN ARBOR MI
48103-1890
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR # J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-887-4396
  • Fax: 734-887-4614
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013583
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004925
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: