Individual provider Active NPI

Kristin Lee Coolidge, FNP-C

  • Family Nurse Practitioner
  • Peoria, AZ
National Provider Identifier
1205519378
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
240929 Issued in AZ
Practice address
8088 W Whitney Dr
Peoria, AZ 85345-6564
Phone
(833) 855-9973
NPI assigned
Aug 7, 2023
Last updated
Aug 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 240929 AZ Primary

Addresses

Primary practice location

8088 W Whitney Dr
Peoria, AZ 85345-6564

Mailing address

8088 W Whitney Dr Ste 2E
Peoria, AZ 85345-6564
Phone (833) 855-9973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231025002210 AZ Practitioner - Nurse Practitioner 1759737810 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
240929AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maricopa County Special Health Care District CurrentSince Sep 27, 2023 Accepting new patients
District Medical Group, Inc CurrentSince Oct 2, 2023 Accepting new patients
District Medical Group, Inc CurrentSince Oct 2, 2023 Accepting new patients
Maricopa County Special Health Care District CurrentSince Sep 27, 2023 Accepting new patients
District Medical Group, Inc Current Accepting new patients

Locations

950 E Van Buren St
Avondale, AZ 85323
Phone (623) 344-6800

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 344-5287

8088 W Whitney Dr
Ste 2E
Peoria, AZ 85345

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

2601 E Roosevelt St
Ste 0D10
Phoenix, AZ 85008

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

33 W Tamarisk St
Phoenix, AZ 85041
Phone (602) 344-6400

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1205519378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8088 W WHITNEY DR STE 2E",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853456564",
            "telephone_number": "833-855-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8088 W WHITNEY DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853456564",
            "telephone_number": "833-855-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLIDGE",
        "first_name": "KRISTIN",
        "middle_name": "LEE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "240929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.