Provider Demographics
NPI:1215189501
Name:PATRICK, KIMBERLY MARIE (ADN-RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:ADN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:608 WRIGHT AVE.
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0069
Mailing Address - Country:US
Mailing Address - Phone:989-463-4971
Mailing Address - Fax:989-463-6515
Practice Address - Street 1:608 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1600
Practice Address - Country:US
Practice Address - Phone:989-463-4971
Practice Address - Fax:989-463-6515
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222756163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse