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Kayla R Licari, PA-C
Medical Physician Assistant in Grand Rapids, Michigan
NPI 1770811903

Kayla R Licari is a Medical Physician Assistant based in Grand Rapids, MI and is specialized in Medical. Kayla R Licari practices in Grand Rapids, MI and has the professional credentials of PA-C. The NPI Number for Kayla R Licari is 1770811903 and holds a License No. 5601005659 (Michigan).

The current practice location address for Kayla R Licari is 3700 52Nd St Se, Grand Rapids, MI and can be reached out via phone at 616-656-3700 and via fax at 616-656-3701.

Location: 3700 52Nd St Se, Grand Rapids, MI, 49512-9637
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Provider Profile Details
NPI Number
1770811903
Provider Name
Kayla R Licari
Credential
PA-C
Provider Entity Type
Individual
Gender
Female
Address
3700 52Nd St Se, Grand Rapids, MI, 49512-9637
Phone Number
616-656-3700
Fax Number
616-656-3701
Provider Enumeration Date
11/30/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
5601005659 01 MI STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
3700 52Nd St Se
City
State
Zip
49512-9637
Phone Number
616-656-3700
Fax Number
616-656-3701
person
Provider Business Mailing Address Details
Address
3700 52Nd St Se
City
State
Zip
49512-9637
Phone Number
616-656-3700
Fax Number
616-656-3701
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
5601005659 (Michigan)
Definition
Definition to come...
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