Doctor Name: | MS. KIMBERLY PATRICE HARRIS |
NPI Number: | 1588626592 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 4704164659 |
Business Practice Address: | 5991 95th Ave Evart, MI - 496319386 |
Business Phone Number: | 2318327000 |
Business Fax Number: | |
Mailing Address: | 5991 95th Ave, EVART |
State: | MI |
Postal Code: | 49631 |
Phone Number: | 2318327000 |
Fax Number: | |
NPI Enumeration Date: | 04/05/2006 |
NPI Last Update Date: | 06/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704164659 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |