Active NPI
Desirae Dyan Delbridge, PA-C
- Medical Physician Assistant
- Clio, MI
National Provider Identifier
1407138399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5601006127
- Practice address
- 4154 W Vienna Rd
Clio, MI 48420-2809 - Phone
- (810) 687-1008
- NPI assigned
- Sep 15, 2011
- Last updated
- Jun 5, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601006127 | MI | Primary |
Addresses
Primary practice location
4154 W Vienna Rd
Clio, MI 48420-2809
Mailing address
225 E 5TH St
Suite 300
Flint, MI 48502-1641
Phone (810) 406-4246
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601006127 | MI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338854400000",
"number": "1407138399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 E 5TH ST",
"address_2": "SUITE 300",
"city": "FLINT",
"state": "MI",
"postal_code": "485021641",
"telephone_number": "810-406-4246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4154 W VIENNA RD",
"city": "CLIO",
"state": "MI",
"postal_code": "484202809",
"telephone_number": "810-687-1008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELBRIDGE",
"first_name": "DESIRAE",
"middle_name": "DYAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-15",
"last_updated": "2012-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601006127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clio, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.