Provider Demographics
NPI:1326582875
Name:HENKEL, KATIE (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HENKEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1037
Mailing Address - Country:US
Mailing Address - Phone:248-717-1232
Mailing Address - Fax:248-717-0150
Practice Address - Street 1:343 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1037
Practice Address - Country:US
Practice Address - Phone:248-717-1232
Practice Address - Fax:248-717-0150
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NVPA0493363AM0700X
NVPA1800363AM0700X
MI5601013076363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant