Kimberly Marie Jaskulka, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704205403 Issued in MI

Practice address

9502 Country Club LN
Davison, MI 48423-7801

Phone

(810) 577-1871

NPI assigned

Oct 25, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diversified Hospice Care, Inc.Group PAC ID 6901061787, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Diversified Hospice Care, Inc.

  • Adult Health Nurse Practitioner
  • Troy, MI
  • NPI 1689351280
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1780406348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9502 COUNTRY CLUB LN",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484237801",
            "telephone_number": "810-577-1871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9502 COUNTRY CLUB LN",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484237801",
            "telephone_number": "810-577-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JASKULKA",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704205403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asif Ishaque, MD
• Isla Smiles PLLC
• Deshaun Jackson
• Kristine Marie Janke-Stefanko
• Terri Lynne Jarvis, OTRL
• Jawad a Shah MD PC
• Alyssa Raeann Jenkins, OTR/L
• Deanne Jones
• Joseph B. Luna M.D., P.C.
• Monica Joshua

• Gerontology Nurse Practitioner in Davison, MI
• Providers in Davison, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.