Provider Demographics
NPI:1366035081
Name:GREEN-SIMS, KIMBERLEY DIANNE
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DIANNE
Last Name:GREEN-SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W BARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1454
Mailing Address - Country:US
Mailing Address - Phone:231-286-9518
Mailing Address - Fax:
Practice Address - Street 1:185 W BARNEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-1454
Practice Address - Country:US
Practice Address - Phone:231-286-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula