Healthcare Provider Details

I. General information

NPI: 1891810578
Provider Name (Legal Business Name): JENNIFER A TIMMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/27/2023
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE M-351
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST SUITE M-351
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8786
  • Fax: 269-341-8984
Mailing address:
  • Phone: 269-341-8786
  • Fax: 269-341-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107108
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number4301107108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: