Provider Demographics
NPI:1740949742
Name:KLOK, KAYLIN JANE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:JANE
Last Name:KLOK
Suffix:
Gender:
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2335 ASHFORD TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5648
Mailing Address - Country:US
Mailing Address - Phone:269-615-3663
Mailing Address - Fax:
Practice Address - Street 1:3200 W CENTRE AVE STE 203
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4889
Practice Address - Country:US
Practice Address - Phone:269-324-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant