Healthcare Provider Details

I. General information

NPI: 1063291730
Provider Name (Legal Business Name): KAYLA ANN POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 FORT ST
LINCOLN PARK MI
48146-1904
US

IV. Provider business mailing address

10927 MELBOURNE AVE
ALLEN PARK MI
48101-1171
US

V. Phone/Fax

Practice location:
  • Phone: 313-466-4000
  • Fax:
Mailing address:
  • Phone: 313-909-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704353588
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704353588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: