Provider Demographics
NPI:1871881185
Name:MORTON, KYNDRA JO (NP-C)
Entity type:Individual
Prefix:
First Name:KYNDRA
Middle Name:JO
Last Name:MORTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MASON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2421
Mailing Address - Country:US
Mailing Address - Phone:810-496-5543
Mailing Address - Fax:810-496-5798
Practice Address - Street 1:725 MASON ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2421
Practice Address - Country:US
Practice Address - Phone:810-496-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner