Kelly Jo Lubbers, DNP, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

212110859-3 Issued in MI

Practice address

2845 44TH St SW Ste 200
Grandville, MI 49418-2678

Phone

(616) 538-2410

NPI assigned

Aug 23, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grandville Pediatrics, P.C.

  • Pediatrics Physician
  • Grandville, MI
  • NPI 1518931732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1063188647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5553 STEVENDALE DR",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494268499",
            "telephone_number": "616-540-6516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 44TH ST SW STE 200",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182678",
            "telephone_number": "616-538-2410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5553 Stevendale Dr",
            "address_purpose": "LOCATION",
            "city": "Hudsonville",
            "state": "MI",
            "postal_code": "494268499",
            "country_code": "US",
            "telephone_number": "616-540-6516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUBBERS",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "DNP, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "212110859-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Living Roots LLC
• Angela Long
• Matthew Ryan Loveless
• Betty Lowell, LPC, CAADC
• Mackenzie Lozon
• Denise Lubbinge
• Luminous Vale PLC
• Katya Luna-Carrera
• Hope Lunde
• Luxottica Retail North America Inc

• Pediatric Nurse Practitioner in Grandville, MI
• Providers in Grandville, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.