Healthcare Provider Details

I. General information

NPI: 1427622182
Provider Name (Legal Business Name): KYLIE LYNN BUTCHART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE LYNN DENNIS PA-C

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE DR SE STE 205
GRAND RAPIDS MI
49546-8292
US

IV. Provider business mailing address

4100 LAKE DR SE
GRAND RAPIDS MI
49546-8292
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: