Healthcare Provider Details

I. General information

NPI: 1659242485
Provider Name (Legal Business Name): DEVONA KACHI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 GREENFIELD RD
BERKLEY MI
48072-1161
US

IV. Provider business mailing address

30079 KINGSWAY DR
FARMINGTON HILLS MI
48331-1711
US

V. Phone/Fax

Practice location:
  • Phone: 248-268-1525
  • Fax: 248-268-1525
Mailing address:
  • Phone: 248-882-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704344754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: