Healthcare Provider Details

I. General information

NPI: 1588510606
Provider Name (Legal Business Name): KIMBERLY ANNE POE MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 ABBOT RD
EAST LANSING MI
48823-1410
US

IV. Provider business mailing address

428 PEACOCK WALK
JACKSON MI
49202-1135
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-5342
  • Fax:
Mailing address:
  • Phone: 517-748-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704387719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: