Basic Information
| Provider Information | |||||||||
| NPI: | 1598428856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUTEL | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | PIERCE | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37558 KAREN ANN CT | ||||||||
| Address2: | |||||||||
| City: | NEW BALTIMORE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480476704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5868732413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42669 GARFIELD RD # 326 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864125321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 4704277447 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.