Healthcare Provider Details

I. General information

NPI: 1245134725
Provider Name (Legal Business Name): KRISTY LAYNE WEST CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHICAGO ST
BROOKLYN MI
49230-9703
US

IV. Provider business mailing address

42956 6TH AVE
BLOOMINGDALE MI
49026-9705
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-1974
  • Fax:
Mailing address:
  • Phone: 517-592-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: