Darby Rae Disselkoen, DNP, APRN, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704320802 Issued in MI

Practice address

8333 Felch St Ste 200
Zeeland, MI 49464-2609

Phone

(616) 748-2850

NPI assigned

Sep 21, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1316618382",
    "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": "8333 FELCH ST STE 200",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494642609",
            "telephone_number": "616-748-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSELKOEN",
        "first_name": "DARBY",
        "middle_name": "RAE",
        "credential": "DNP, APRN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704320802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn D Dewitt, MD
• Lindsay Dewys
• Emilie Deyoung, LMSW, ACSW
• Emily E Deyoung
• Lisa Diephouse, PHARMD
• Stanley Allen Dombroski, DC
• Carli Denholm Donnelly, M.D.
• Dr. WM J Gras PHD MD PC
• Kari Dressler, NP
• Robert Drew

• Pediatric Nurse Practitioner in Zeeland, MI
• Providers in Zeeland, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; 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.