Basic Information
Provider Information
NPI: 1447785639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOLEY
FirstName: KIMBERLY
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: AGACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: VERMEESCH
OtherFirstName: KIMBERLY
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2: FLOOR 3 CARDIOVASCULAR CENTER
City: ANN ARBOR
State: MI
PostalCode: 481095856
CountryCode: US
TelephoneNumber: 8882871082
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/25/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704304801MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LA2100X4704304801MIN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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