| Doctor Name: | MRS. KAY LYNN SOUTHWELL |
| NPI Number: | 1730320623 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 4704216251 |
| Business Practice Address: | 4154 W Vienna Rd Clio, MI - 484202809 |
| Business Phone Number: | 8106863747 |
| Business Fax Number: | 8106864794 |
| Mailing Address: | 4154 W Vienna Rd, CLIO |
| State: | MI |
| Postal Code: | 484202809 |
| Phone Number: | 8106863747 |
| Fax Number: | 8106864794 |
| NPI Enumeration Date: | 03/23/2009 |
| NPI Last Update Date: | 06/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 4704216251 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |