Active NPI
Kellie Rae Kroll, CPNP-PC
- Nurse Practitioner
- Westland, MI
National Provider Identifier
1083296834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704294238NSA2001Q
- Practice address
- 8623 N Wayne Rd Ste 123
Westland, MI 48185-1137 - Phone
- (734) 367-0469
- NPI assigned
- Apr 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704294238NSA2001Q | MI | Primary |
Addresses
Primary practice location
8623 N Wayne Rd Ste 123
Westland, MI 48185-1137
Mailing address
1992 Wiltshire Rd
Berkley, MI 48072-3313
Phone (248) 320-4828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704294238NSA2001Q | MI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619049600000",
"number": "1083296834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1992 WILTSHIRE RD",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480723313",
"telephone_number": "248-320-4828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8623 N WAYNE RD STE 123",
"city": "WESTLAND",
"state": "MI",
"postal_code": "481851137",
"telephone_number": "734-367-0469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROLL",
"first_name": "KELLIE",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "CPNP-PC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-22",
"last_updated": "2021-04-22",
"certification_date": "2021-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704294238NSA2001Q",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.