MEDICARE: KIMBERLY TRUCKNER MSN, FNP-BC

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	163W00000X	Registered Nurse	4704289982	MI
2	363LF0000X	Family Nurse Practitioner	F10180830	MI

General Provider Information

NPI Number	:	1538635842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY TRUCKNER MSN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 5352
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-0352
Country	:	US
Telephone Number	:	989-860-0088
Fax Number	:	989-791-3859

Provider Business Practice Location Address
First Line	:	611 W BELLE AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-1611
Country	:	US
Telephone Number	:	989-865-9958
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	02/17/2023

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