Provider Demographics
NPI:1891532081
Name:DANTZLER-MORGAN, KYLIA JOYCE (CBD)
Entity type:Individual
Prefix:MS
First Name:KYLIA
Middle Name:JOYCE
Last Name:DANTZLER-MORGAN
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BATES ST SE APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2667
Mailing Address - Country:US
Mailing Address - Phone:616-477-1010
Mailing Address - Fax:
Practice Address - Street 1:1108 BATES ST SE APT 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2667
Practice Address - Country:US
Practice Address - Phone:616-477-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker