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General NPI Number Information
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NPI Number | 1942996129
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Entity Type | Individual
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Provider Name | KYLEIGH FOWLER
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Gender | Female
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 300 68TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49548-6927
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Country | US
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Telephone | 616-455-5000
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Fax | 616-281-6459
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Provider Business Mailing Address
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Address Line | 4829 E BELTLINE AVE NE STE 310
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9350
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Country | US
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Telephone | 616-279-6414
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Fax | 616-591-3393
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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