Kooienga, Jack A

Kooienga, Jack A is an individual health care provider with primary practice located at 5900 Byron Center Ave Sw , Wyoming MI 49519-9606. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is his primary health care specialty. Kooienga, Jack A can be contacted via phone (616) 252-7200.

Contact Information

Primary practice address
5900 Byron Center Ave Sw Wyoming MI 49519-9606
Phone: (616) 252-7200
Fax: (616) 252-7830
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Critical Care Medicine 363LC0200X 4704218318 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X APRN11012762 Florida

Profile Details

NPI number 1518216308
LBN Legal business name Kooienga, Jack A
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2012
Last updated Aug 9th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518216308 NPPES
Florida MEDICAID 110773300

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