| Doctor Name: | KIMBERLY A PREVOST |
| NPI Number: | 1295946044 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3051 Commerce Dr Ste 5 Fort Gratiot, MI - 480593866 |
| Business Phone Number: | 8103854463 |
| Business Fax Number: | 8103858875 |
| Mailing Address: | 1040 Summer St, ALGONAC |
| State: | MI |
| Postal Code: | 480011294 |
| Phone Number: | 8107942083 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |