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General NPI Number Information
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NPI Number | 1598428856
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Entity Type | Individual
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Provider Name | KEVIN PIERCE BAUTEL PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 03/26/2023
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Provider Practice Location Address
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Address Line | 42669 GARFIELD RD # 326
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1653
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Country | US
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Telephone | 586-412-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 37558 KAREN ANN CT
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-6704
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Country | US
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Telephone | 586-873-2413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704277557
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License Number State | MI
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