Individual
MS. KAITLIN JACKLENE HOLCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(586) 615-7769
Mailing address
2799 W GRAND BLVD # K14, DETROIT, MI 48202-2689
(313) 916-2695
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.011658
IL
363LF0000X
Family Nurse Practitioner
Primary
4704285017
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902205818
—
MI
01
—
4704285017
RN AND APN LICENSE
MI
Enumeration date
08/15/2014
Last updated
03/07/2023
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