Individual
KIMBERLY MARIE NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4543 S M 88 HWY, BELLAIRE, MI 49615-9109
(231) 533-8661
(231) 533-6028
Mailing address
PO BOX 30516, LANSING, MI 48909-8016
(231) 346-6800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004234
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601004234
PA LICENSE
MI
Enumeration date
05/23/2006
Last updated
03/07/2023
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