Healthcare Provider Details

I. General information

NPI: 1841117173
Provider Name (Legal Business Name): KAITLYN JANELLE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYN JANELLE KNAPP

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S PARK ST
KALAMAZOO MI
49007-5118
US

IV. Provider business mailing address

524 S PARK ST
KALAMAZOO MI
49007-5118
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6056
  • Fax: 269-341-7781
Mailing address:
  • Phone: 269-341-6056
  • Fax: 269-341-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014205
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: