Healthcare Provider Details

I. General information

NPI: 1114439395
Provider Name (Legal Business Name): KRISTEN SKONEY MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49248 BERKSHIRE DR
CHESTERFIELD MI
48047-1769
US

IV. Provider business mailing address

1170 MICHIGAN RD
PORT HURON MI
48060-4658
US

V. Phone/Fax

Practice location:
  • Phone: 586-306-0107
  • Fax:
Mailing address:
  • Phone: 586-306-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704289603
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: