Provider Demographics
NPI:1508659509
Name:KAKUK, KYLE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:
Last Name:KAKUK
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:MISS
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 W WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4031
Mailing Address - Country:US
Mailing Address - Phone:906-239-5050
Mailing Address - Fax:906-239-5055
Practice Address - Street 1:1025 W WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4031
Practice Address - Country:US
Practice Address - Phone:906-239-5050
Practice Address - Fax:906-239-5055
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health