Provider Demographics
NPI:1437399854
Name:KRAFT, KATHLEEN LOUISE (MSN, PMHNP-C, ANP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MSN, PMHNP-C, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35186 AUTOMATION DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3113
Mailing Address - Country:US
Mailing Address - Phone:586-600-7462
Mailing Address - Fax:586-204-0268
Practice Address - Street 1:35186 AUTOMATION DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3113
Practice Address - Country:US
Practice Address - Phone:586-600-7462
Practice Address - Fax:586-204-0268
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112003363LP0808X
MI4704202988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health