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General NPI Number Information
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NPI Number | 1518479435
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN KILEY LPN
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Gender | Female
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 5300 PATTERSON AVE SE STE 125
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-9627
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Country | US
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Telephone | 616-222-5601
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Fax | 866-941-7479
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Provider Business Mailing Address
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Address Line | 230 S EXCHANGE ST
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City | LAWRENCE
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State | MI
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Zip | 49064-9407
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Country | US
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Telephone | 269-370-9491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703107267
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License Number State | MI
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