Healthcare Provider Details

I. General information

NPI: 1558502757
Provider Name (Legal Business Name): KIA LYNNE HENKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3404 MILLER RD
FLINT MI
48507-1238
US

IV. Provider business mailing address

G3404 MILLER RD
FLINT MI
48507-1238
US

V. Phone/Fax

Practice location:
  • Phone: 810-238-4172
  • Fax:
Mailing address:
  • Phone: 810-238-4172
  • Fax: 810-238-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704202465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: