Healthcare Provider Details

I. General information

NPI: 1942174453
Provider Name (Legal Business Name): KAITLYN WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ROBERT JONES WAY FL 2
KALAMAZOO MI
49009-1904
US

IV. Provider business mailing address

6223 SHAWNEE CIR
SCOTTS MI
49088-9766
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-7466
  • Fax: 269-492-0660
Mailing address:
  • Phone: 517-581-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704333304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: