Provider Demographics
NPI:1568847077
Name:KUTZ, AMY MICHELLE (CNM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:KAISER PERMANENTE FOLSOM MEDICAL OFFICES,
Mailing Address - Street 2:2155 IRON POINT ROAD
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-517-2311
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE FOLSOM MEDICAL OFFICES,
Practice Address - Street 2:2155 IRON POINT ROAD
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-517-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-26
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF1001694-1367A00000X
TXAP130160367A00000X
CA236035176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373816301Medicaid
TX373816302Medicaid