Active NPI
Wendy Kimberly
- Behavior Technician
- Fort Gratiot, MI
National Provider Identifier
1235941972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 3847 Pine Grove Ave Ste B
Fort Gratiot, MI 48059-4265 - Phone
- (586) 228-9991
- NPI assigned
- Jan 21, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | MI | Primary |
Addresses
Primary practice location
3847 Pine Grove Ave Ste B
Fort Gratiot, MI 48059-4265
Mailing address
5435 Lakeshore Rd
Fort Gratiot, MI 48059-3120
Phone (517) 917-6528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737417600000",
"number": "1235941972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5435 LAKESHORE RD",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480593120",
"telephone_number": "517-917-6528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3847 PINE GROVE AVE STE B",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480594265",
"telephone_number": "586-228-9991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBERLY",
"first_name": "WENDY",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-21",
"last_updated": "2025-01-21",
"certification_date": "2025-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gratiot, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.