Provider Demographics
NPI:1043088008
Name:CARPENTER, KIMBERLY NICOLE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11034 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277-9744
Mailing Address - Country:US
Mailing Address - Phone:479-866-9250
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0411
Practice Address - Country:US
Practice Address - Phone:517-887-0226
Practice Address - Fax:517-887-8121
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator