Healthcare Provider Details

I. General information

NPI: 1467044941
Provider Name (Legal Business Name): KYLIE J KATTELUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2021
Last Update Date: 06/08/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N SHIAWASSEE ST STE 110
OWOSSO MI
48867-1601
US

IV. Provider business mailing address

819 N SHIAWASSEE ST STE 110
OWOSSO MI
48867-1601
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-1390
  • Fax: 989-725-1415
Mailing address:
  • Phone: 989-723-1390
  • Fax: 989-725-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704275840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: