Provider Demographics
NPI:1811791957
Name:FEETHAM, KORY JOHN
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:JOHN
Last Name:FEETHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18900 16 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-8727
Mailing Address - Country:US
Mailing Address - Phone:231-598-9230
Mailing Address - Fax:231-598-9232
Practice Address - Street 1:18900 16 MILE RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-8727
Practice Address - Country:US
Practice Address - Phone:231-598-9230
Practice Address - Fax:231-598-9232
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty