Kristine A Petlick

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361005132 Issued in MI

Practice address

5675 Fairview St
Stevensville, MI 49127-1033

Phone

(269) 429-7727

Fax

(269) 429-5754

NPI assigned

Feb 27, 2008

Last updated

Jan 13, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Medicare reassignment NPD
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment NPD
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals (MDPP)

  • Community Health Clinic/Center
  • Saint Joseph, MI
  • NPI 1184513731
  NPD
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1144499864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5675 FAIRVIEW ST",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491271033",
            "telephone_number": "269-429-7727",
            "fax_number": "269-429-5754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5675 FAIRVIEW ST",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491271033",
            "telephone_number": "269-429-7727",
            "fax_number": "269-429-5754"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "133 W Main St",
            "address_purpose": "LOCATION",
            "city": "Benton Harbor",
            "state": "MI",
            "postal_code": "490223607",
            "country_code": "US",
            "telephone_number": "269-408-2258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETLICK",
        "first_name": "KRISTINE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-27",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301013815",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361005132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly J Nelson, NP
• Becka O'Neil
• Kenneth J O'Neill, MD
• James Allen Organ, RN
• Jeffrey Paul Ott, DPT
• Physiotherapy Associates Inc
• Brandon Scott Pierce, LMSW
• Christopher Addison Prince, MD
• Christine Marie Ramirez, M.D.
• Kara Reinhardt

• Psychologist in Stevensville, MI
• Providers in Stevensville, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.