Individual
MRS. KIMBERLY ELIZABETH WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
37304 KINGS HWY, BEAVER ISLAND, MI 49782-5134
(231) 448-2275
Mailing address
37304 KINGS HWY, BEAVER ISLAND, MI 49782-5134
(231) 448-2275
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
06/12/2009
Last updated
05/29/2026
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