Healthcare Provider Details

I. General information

NPI: 1902738305
Provider Name (Legal Business Name): MRS. KIMBERLY NICOLE HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LAKEVIEW AVE
SAINT JOSEPH MI
49085-2379
US

IV. Provider business mailing address

1495 OAK TER
SAINT JOSEPH MI
49085-9722
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-4368
  • Fax: 269-408-4368
Mailing address:
  • Phone: 269-326-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: