Provider Demographics
NPI:1457821084
Name:TRAVER, KIMBERLY L (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:TRAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LYNNE
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:130 TOWN CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-619-3100
Mailing Address - Fax:248-619-9031
Practice Address - Street 1:130 TOWN CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-619-3100
Practice Address - Fax:248-619-9031
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily