Healthcare Provider Details

I. General information

NPI: 1194519595
Provider Name (Legal Business Name): KAYLA ELAINE VANBUREN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E BELLOWS ST
MT PLEASANT MI
48858-3872
US

IV. Provider business mailing address

3938 HAIGH RD
BEAVERTON MI
48612-8301
US

V. Phone/Fax

Practice location:
  • Phone: 989-953-5814
  • Fax:
Mailing address:
  • Phone: 989-387-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704335822NSA2411E
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: