Healthcare Provider Details

I. General information

NPI: 1235040726
Provider Name (Legal Business Name): KAYLA MACKENZIE HARRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4304 PAGE AVE
MICHIGAN CENTER MI
49254-1078
US

IV. Provider business mailing address

9855 REYNOLDS RD
HORTON MI
49246-9763
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-9189
  • Fax: 517-784-9657
Mailing address:
  • Phone: 517-748-9189
  • Fax: 517-784-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704344903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: