Provider Demographics
NPI:1417618224
Name:JAMES, KIMBERLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 CHEVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-9314
Mailing Address - Country:US
Mailing Address - Phone:810-499-7270
Mailing Address - Fax:
Practice Address - Street 1:5988 STATE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MI
Practice Address - Zip Code:48741-5111
Practice Address - Country:US
Practice Address - Phone:989-683-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293337163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse