Healthcare Provider Details

I. General information

NPI: 1568713998
Provider Name (Legal Business Name): KENDRA ANN CALHOUN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FORT ST
TRENTON MI
48183-4601
US

IV. Provider business mailing address

1819 3RD ST
WYANDOTTE MI
48192-4001
US

V. Phone/Fax

Practice location:
  • Phone: 734-642-2132
  • Fax:
Mailing address:
  • Phone: 734-285-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704232995
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704232995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: