Individual provider Active NPI

Kimberly Sue Kaylor, F.N.P.

  • Family Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1609061506
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704222651 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(313) 916-1755
Fax
(313) 916-7263
NPI assigned
Sep 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704222651 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-1755

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071109000235 MI Practitioner - Nurse Practitioner 0345338224 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704222651MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth L Gwinn MD PC CurrentSince Feb 8, 2020 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Henry Ford Health System Nurse Practitioner CurrentSince Mar 1, 2016 Accepting new patients
Henry Ford Health System CurrentSince Mar 1, 2016 Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

21400 Kelly Rd
Eastpointe, MI 48021
Phone (586) 779-8779

15959 Hall Rd
Ste LL104
Macomb, MI 48044
Phone (586) 799-1212

39450 W Twelve Mile Rd
Novi, MI 48377
Phone (248) 344-0710

Interoperability endpoints

  • Direct secure messaging: kkaylor395141@direct.hfhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1609061506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-1755",
            "fax_number": "313-916-7263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-1755",
            "fax_number": "313-916-7263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAYLOR",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704222651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.