MEDICARE: KIMBERLEY DIANNE GREEN-SIMS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1366035081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY DIANNE GREEN-SIMS

Provider Business Mailing Address
First Line	:	185 W BARNEY AVE
Second Line	:
City	:	MUSKEGON HEIGHTS
State	:	MI
Zip	:	49444-1454
Country	:	US
Telephone Number	:	231-286-9518
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 W BARNEY AVE
Second Line	:
City	:	MUSKEGON HEIGHTS
State	:	MI
Zip	:	49444-1454
Country	:	US
Telephone Number	:	231-286-9518
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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Directions to “ KIMBERLEY DIANNE GREEN-SIMS ” Practice Location

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