Provider Demographics
NPI:1679469605
Name:MAHONE, KIMBERLY (BS PUBLIC HEALTH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MAHONE
Suffix:
Gender:F
Credentials:BS PUBLIC HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1067
Mailing Address - Country:US
Mailing Address - Phone:231-750-7000
Mailing Address - Fax:
Practice Address - Street 1:900 3RD ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1152
Practice Address - Country:US
Practice Address - Phone:231-750-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist