Healthcare Provider Details

I. General information

NPI: 1639363203
Provider Name (Legal Business Name): MICHELLE JOY KIPROP RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE JOY KERNS RN,NP

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

IV. Provider business mailing address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

V. Phone/Fax

Practice location:
  • Phone: 213-673-4849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: