Individual provider Active NPI

Gladys O Kuik, NP CERTIFICATION

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1386334167
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704291158 Issued in MI
Practice address
3950 Sparks Dr SE Ste 103
Grand Rapids, MI 49546-6159
Phone
(517) 882-3732
NPI assigned
May 15, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704291158 MI Primary

Addresses

Primary practice location

3950 Sparks Dr SE Ste 103
Grand Rapids, MI 49546-6159

Mailing address

189 Waxwing CT
Cedar Springs, MI 49319-8162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20230715000556 MI Practitioner - Nurse Practitioner 1658731161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

3950 Sparks Dr SE
Suite 103
Grand Rapids, MI 49546-6159
Phone (517) 882-3732

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704291158MIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Downriver Mental Health Clinic PC CurrentSince Jul 12, 2023 Accepting new patients
Downriver Mental Health Clinic PC CurrentSince Jul 12, 2023 Accepting new patients

Locations

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

3950 Sparks Dr SE
Ste 103
Grand Rapids, MI 49546
Phone (616) 455-5000

20500 Eureka Rd
Ste 200
Taylor, MI 48180
Phone (734) 285-8282

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.gladyskuik@150339.advancedmd-direct.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1386334167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 WAXWING CT",
            "city": "CEDAR SPRINGS",
            "state": "MI",
            "postal_code": "493198162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 SPARKS DR SE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466159",
            "telephone_number": "517-882-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUIK",
        "first_name": "GLADYS",
        "middle_name": "O",
        "credential": "NP CERTIFICATION",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704291158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.