Active NPI
Krysandra Lynn Phelan, LMSW
- Social Worker
- Ira, MI
National Provider Identifier
1093983173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801089204
- Practice address
- 9844 Dixie Hwy
Ira, MI 48023-2813 - Phone
- (810) 434-6371
- NPI assigned
- Feb 12, 2008
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801089204 | MI | Primary |
Addresses
Primary practice location
9844 Dixie Hwy
Ira, MI 48023-2813
Mailing address
9844 Dixie Hwy
Ira, MI 48023-2813
Phone (810) 434-6371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093983173 | Medicaid | MI |
Other names 1
- Miss Krysandra Lynn Grewe
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801089204 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344211200000",
"number": "1093983173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9844 DIXIE HWY",
"city": "IRA",
"state": "MI",
"postal_code": "480232813",
"telephone_number": "810-434-6371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9844 DIXIE HWY",
"city": "IRA",
"state": "MI",
"postal_code": "480232813",
"telephone_number": "810-434-6371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "KRYSANDRA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-12",
"last_updated": "2012-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801089204",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1093983173",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRYSANDRA",
"last_name": "GREWE",
"middle_name": "LYNN",
"prefix": "MISS",
"credential": "LMSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ira, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.