Healthcare Provider Details

I. General information

NPI: 1922593847
Provider Name (Legal Business Name): KYLE TAYLOR DNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S MAIN ST FL 2
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

PO BOX 655
ALPENA MI
49707-0655
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-7118
  • Fax: 231-363-1822
Mailing address:
  • Phone: 231-627-7118
  • Fax: 231-363-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704292758
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: