Healthcare Provider Details

I. General information

NPI: 1700216108
Provider Name (Legal Business Name): JENNIFER KOOL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KOOL NP

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 S 12TH ST STE 200
PORTAGE MI
49024-3831
US

IV. Provider business mailing address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8585
  • Fax:
Mailing address:
  • Phone: 269-349-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: