Healthcare Provider Details

I. General information

NPI: 1720963226
Provider Name (Legal Business Name): KENNETH JAMES YAKLIN MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TORREY RD STE 100
FENTON MI
48430-3327
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax: 810-215-1334
Mailing address:
  • Phone: 517-492-0517
  • Fax: 810-215-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number47042804374
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: