Active NPI
Jacqueline Stacey Keegstra, PHARM D
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1356562854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034165
- Practice address
- 1471 Grace Street
Grand Rapids, MI 49506 - Phone
- (616) 913-2020
- NPI assigned
- May 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302034165 | MI | Primary |
Addresses
Primary practice location
1471 Grace Street
Grand Rapids, MI 49506
Mailing address
5866 E Grove Dr SE
Kentwood, MI 49512
Phone (616) 554-9890
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302034165 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356562854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5866 E GROVE DR SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "49512",
"telephone_number": "616-554-9890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 GRACE STREET",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49506",
"telephone_number": "616-913-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEEGSTRA",
"first_name": "JACQUELINE",
"middle_name": "STACEY",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.