Provider Demographics
NPI:1598942914
Name:HARTMAN, KIMBERLY FAITH (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FAITH
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:FAITH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:4700 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8001
Mailing Address - Country:US
Mailing Address - Phone:616-662-2011
Mailing Address - Fax:616-662-2222
Practice Address - Street 1:2332 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1955
Practice Address - Country:US
Practice Address - Phone:616-391-6236
Practice Address - Fax:616-365-7200
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKH234975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704234975OtherLICENSE NUMBER