1538635842 NPI number — KIMBERLY TRUCKNER MSN, FNP-BC

Table of content: KIMBERLY TRUCKNER MSN, FNP-BC (NPI 1538635842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538635842 NPI number — KIMBERLY TRUCKNER MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUCKNER
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538635842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603-0352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-860-0088
Provider Business Mailing Address Fax Number:
989-791-3859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 W BELLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48655-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-865-9958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  4704289982 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F10180830 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)