Healthcare Provider Details

I. General information

NPI: 1679161848
Provider Name (Legal Business Name): KAYLEE MAE CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 FRESNO CIR SE
GRAND RAPIDS MI
49548-8598
US

IV. Provider business mailing address

4747 W RIVER DR NE
COMSTOCK PARK MI
49321-8969
US

V. Phone/Fax

Practice location:
  • Phone: 616-570-6370
  • Fax:
Mailing address:
  • Phone: 616-773-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: