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NPI Code Detail

MEDICARE: KIMBERLY J NELSON NP

MEDICARE: KIMBERLY J NELSON NP
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
1363L00000XNurse Practitioner4704164646MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700993441
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY J NELSON NP
Provider Business Mailing Address
First Line : 4368 CLEVELAND AVE
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9595
Country : US
Telephone Number : 269-983-6501
Fax Number : 269-983-2237
Provider Business Practice Location Address
First Line : 4368 CLEVELAND AVE
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9595
Country : US
Telephone Number : 269-983-6501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 03/24/2026

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