Healthcare Provider Details

I. General information

NPI: 1164396925
Provider Name (Legal Business Name): KATHRYN MARIE KUMOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 323
GRAND RAPIDS MI
49505-4674
US

IV. Provider business mailing address

1345 MONROE AVE NW STE 323
GRAND RAPIDS MI
49505-4674
US

V. Phone/Fax

Practice location:
  • Phone: 616-512-3210
  • Fax: 855-231-2592
Mailing address:
  • Phone: 616-512-3210
  • Fax: 855-231-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704279790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: