Provider Demographics
NPI:1710381520
Name:AMON, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:AMON
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 1:7175 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9550
Mailing Address - Country:US
Mailing Address - Phone:810-845-9195
Mailing Address - Fax:
Practice Address - Street 1:7175 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9550
Practice Address - Country:US
Practice Address - Phone:810-845-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703040539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse