Kristin Dykstra, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005234 Issued in MI

Practice address

4069 Lake Dr SE
Suite 312
Grand Rapids, MI 49546-8816

Phone

(616) 267-8700

Fax

(616) 267-8247

NPI assigned

Apr 24, 2008

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

Other names 1

• Kristin Cole Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Michigan Medical Patient Care

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1073567806
  NPD (past)
• Michigan Medical Patient Care

  • Durable Medical Equipment & Medical Supplies
  • Holland, MI
  • NPI 1871741652
  NPD (past)

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1417122011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4069 LAKE DR SE",
            "address_2": "SUITE 312",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468816",
            "telephone_number": "616-267-8700",
            "fax_number": "616-267-8247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "KRISTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "COLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janice Lynne Dykstra, LPC
• Jason P Dykstra, MD
• John A Dykstra, PA-C
• Joseph Henry Dykstra, ATC
• Kevin James Dykstra, MDIV, MA, LLPC
• Lois R Dykstra, RN
• Marsha Dykstra, LPC
• Matthew William Dykstra, NP
• Sarah M Dykstra
• Sidney Dykstra, LMSW, CAADC

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.