Active NPI
Kimberly Patrick
- Family Nurse Practitioner
- Canton, MI
National Provider Identifier
1285268078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704267415
- Practice address
- 45300 Cherry Hill Rd
Canton, MI 48187-5073 - Phone
- (866) 389-3272
- NPI assigned
- Mar 2, 2020
- Last updated
- Nov 10, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704267415 | MI | Primary |
Addresses
Primary practice location
45300 Cherry Hill Rd
Canton, MI 48187-5073
Mailing address
6599 Kings Mill Dr
Canton, MI 48187-5476
Phone (734) 578-2621
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704267415 | MI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1285268078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6599 KINGS MILL DR",
"city": "CANTON",
"state": "MI",
"postal_code": "481875476",
"telephone_number": "734-578-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45300 CHERRY HILL RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481875073",
"telephone_number": "866-389-3272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATRICK",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-02",
"last_updated": "2020-11-10",
"certification_date": "2020-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704267415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.