MEDICARE: MRS. KIMBERLY L VERELLEN PA-C

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	363A00000X	Physician Assistant	5601003348	MI

General Provider Information

NPI Number	:	1891755104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY L VERELLEN PA-C

Provider Business Mailing Address
First Line	:	228 SCHOOL HOUSE DR
Second Line	:
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-1242
Country	:	US
Telephone Number	:	810-724-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	4472 MAIN ST
Second Line	:
City	:	BROWN CITY
State	:	MI
Zip	:	48416-7908
Country	:	US
Telephone Number	:	810-346-2751
Fax Number	:	810-346-3238

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/17/2011

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Directions to “ MRS. KIMBERLY L VERELLEN PA-C” Practice Location

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