Healthcare Provider Details

I. General information

NPI: 1417618224
Provider Name (Legal Business Name): KIMBERLEY JAMES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5988 STATE ST
KINGSTON MI
48741-5111
US

IV. Provider business mailing address

4225 CHEVINGTON RD
DECKERVILLE MI
48427-9314
US

V. Phone/Fax

Practice location:
  • Phone: 989-683-2221
  • Fax:
Mailing address:
  • Phone: 810-499-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704293337
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704293337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: