MEDICARE: NICOLE KEMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1255273462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE KEMP

Provider Business Mailing Address
First Line	:	1132 E MAPLE AVE
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48507-4108
Country	:	US
Telephone Number	:	833-478-9464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 E MAPLE AVE
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48507-4108
Country	:	US
Telephone Number	:	833-478-9464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ NICOLE KEMP ” Practice Location

Language	Start Address	Practice Location

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