Healthcare Provider Details

I. General information

NPI: 1275386641
Provider Name (Legal Business Name): KIMBERLY OBOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E NORTH COUNTY LINE RD
SAINT LOUIS MI
48880-9709
US

IV. Provider business mailing address

104 E NORTH COUNTY LINE RD
SAINT LOUIS MI
48880-9709
US

V. Phone/Fax

Practice location:
  • Phone: 989-763-1518
  • Fax:
Mailing address:
  • Phone: 989-763-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: