Healthcare Provider Details

I. General information

NPI: 1538094065
Provider Name (Legal Business Name): MRS. KINYETTA AMOUR BRANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CORPORATE DR
TROY MI
48098-2859
US

IV. Provider business mailing address

17 OAK CREEK LN
PONTIAC MI
48340-2219
US

V. Phone/Fax

Practice location:
  • Phone: 313-427-5840
  • Fax: 313-427-5840
Mailing address:
  • Phone: 313-427-5840
  • Fax: 313-427-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851121924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: