Provider Demographics
NPI:1831562610
Name:KRUMMREY, KIMBERLEY (DNP, PMHNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:KRUMMREY
Suffix:
Gender:F
Credentials:DNP, PMHNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-1417
Mailing Address - Country:US
Mailing Address - Phone:517-579-3499
Mailing Address - Fax:517-579-3599
Practice Address - Street 1:301 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-1417
Practice Address - Country:US
Practice Address - Phone:517-579-3499
Practice Address - Fax:517-579-3599
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1831562610Medicaid
MI0M61830061Medicare PIN