Individual
KYLE M FARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
640 STARKWEATHER ST STE C, PLYMOUTH, MI 48170-1371
(734) 259-2804
(734) 259-2805
Mailing address
1856 TRADITION DR, CANTON, MI 48187-5808
(269) 352-8031
(734) 259-2805
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704253005
MI
363LF0000X
Family Nurse Practitioner
4704253005
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12304421
CAQH
MI
Enumeration date
07/28/2011
Last updated
01/09/2024
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