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NPI Code Detail

MEDICARE: KIMBERLY LYNN KILEY LPN

MEDICARE: KIMBERLY LYNN KILEY LPN
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
1164W00000XLicensed Practical Nurse4703107267MI

General Provider Information

NPI Number : 1518479435
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY LYNN KILEY LPN
Provider Business Mailing Address
First Line : 230 S EXCHANGE ST
Second Line :
City : LAWRENCE
State : MI
Zip : 49064-9407
Country : US
Telephone Number : 269-370-9491
Fax Number :
Provider Business Practice Location Address
First Line : 5300 PATTERSON AVE SE STE 125
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9627
Country : US
Telephone Number : 616-222-5601
Fax Number : 866-941-7479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2017
Last Update Date : 11/01/2017

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Directions to “ KIMBERLY LYNN KILEY LPN” Practice Location

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