Krista Delong, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601003308 Issued in MI

Practice address

15100 Whittaker Way
Grand Haven, MI 49417-8696

Phone

(616) 935-6300

NPI assigned

Jun 7, 2006

Last updated

Mar 2, 2021By the provider in NPPES

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

Other names 1

• Krista Hansen Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kdelong103822@epic00.corewelldirect.org

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1144260266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15100 WHITTAKER WAY",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178696",
            "telephone_number": "616-935-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELONG",
        "first_name": "KRISTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdelong103822@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "15100 Whittaker Way",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494178696",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "15100 Whittaker Way",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494178696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "HANSEN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William J Deaton, DO
• Wanda Hatmaker Decker, LMSW
• Jennifer Deckert, LPC
• Terry R Degroot, M.D.
• Karin J Dekorver, NP
• Lee J Demeester, MD
• Link A Dephouse, PT
• Kathryn Jean Devinney, CPNP-PC
• Sarah Marie Devisser, LMSW
• Tarin Lee Devoursney, M.D.

• Medical Physician Assistant in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.