Provider Demographics
NPI:1831782366
Name:OTTEN, AUSTYN KAY (NP)
Entity type:Individual
Prefix:
First Name:AUSTYN
Middle Name:KAY
Last Name:OTTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AUSTYN
Other - Middle Name:KAY
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 NAKOMA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2829
Mailing Address - Country:US
Mailing Address - Phone:616-808-6323
Mailing Address - Fax:
Practice Address - Street 1:1509 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1113
Practice Address - Country:US
Practice Address - Phone:989-386-8170
Practice Address - Fax:989-386-8175
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254199363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner