Healthcare Provider Details

I. General information

NPI: 1386462901
Provider Name (Legal Business Name): KENDRA TAYLOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8379 S MASON DR
NEWAYGO MI
49337-9140
US

IV. Provider business mailing address

8379 S MASON DR
NEWAYGO MI
49337-9140
US

V. Phone/Fax

Practice location:
  • Phone: 231-403-5000
  • Fax:
Mailing address:
  • Phone: 231-403-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704301539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: