Healthcare Provider Details

I. General information

NPI: 1982204640
Provider Name (Legal Business Name): KAITLYN RENEA HILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEALTH PARK BLVD
GRAND BLANC MI
48439-2558
US

IV. Provider business mailing address

600 HEALTH PARK BLVD
GRAND BLANC MI
48439-2558
US

V. Phone/Fax

Practice location:
  • Phone: 810-603-8400
  • Fax:
Mailing address:
  • Phone: 810-625-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704322483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: