Kathy Diane Reid, APRN,BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704133106 Issued in MI

Practice address

1000 Pavillions Cir
Traverse City, MI 49684-3198

Phone

(231) 932-3801

Fax

(231) 421-3789

NPI assigned

Aug 11, 2005

Last updated

Oct 28, 2015By 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Indigo Hospital Medicine - Cadillac, PLC

  • Internal Medicine Physician
  • Cadillac, MI
  • NPI 1770734907
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1174525042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 E TRAVERSE HWY",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496841364",
            "telephone_number": "231-346-6930",
            "fax_number": "231-346-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PAVILLIONS CIR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843198",
            "telephone_number": "231-932-3801",
            "fax_number": "231-421-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REID",
        "first_name": "KATHY",
        "middle_name": "DIANE",
        "credential": "APRN,BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704133106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4570969",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Reichardt, D.O.
• Alisha Ann Reichenbach, OTR/L
• Ann Reichert
• Jenny E Reid
• Katelyn Anne Reid
• John Robert Reineck, M.D.
• Adam R Reinhart, P.A.
• Eric Reinhold
• Christine Reitmeyer
• Emily Autumn Reitzel, MD

• Gerontology Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.