Healthcare Provider Details

I. General information

NPI: 1992298087
Provider Name (Legal Business Name): DR. NICOLE MARIE KITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE OUTMAN

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W WACKERLY ST STE 11
MIDLAND MI
48640-2769
US

IV. Provider business mailing address

2520 UNIVERSITY PARK
MOUNT PLEASANT MI
48858-4464
US

V. Phone/Fax

Practice location:
  • Phone: 989-832-2165
  • Fax:
Mailing address:
  • Phone: 989-774-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: