Active NPI
Kristin Elizabeth Grapes, PH.D.
- Adult Development & Aging Psychologist
- Winston Salem, NC
National Provider Identifier
1427089671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Development & Aging Psychologist
- License
- 673
- Practice address
- 2910 Briarcliff Road
Winston Salem, NC 27106-3176 - Phone
- (336) 407-6764
- NPI assigned
- Jul 5, 2006
- Last updated
- Jun 13, 2016
- 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 |
|---|---|---|---|---|
| Adult Development & Aging Psychologist | 103TA0700X | 673 | NC | Primary |
Addresses
Primary practice location
2910 Briarcliff Road
Winston Salem, NC 27106-3176
Mailing address
2910 Briarcliffe Rd
Suite 604-B
Winston Salem, NC 27106-3176
Phone (336) 407-6764
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1582323 | Other | NC | VALUE OPTIONS |
| 6114757 | Other | NC | UNITED BEHAVIORAL HEALTH |
| 03629 | Other | NC | BLUE CROSS BLUE SHEILD |
| 6000520 | Medicaid | NC |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 673 | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465776000000",
"number": "1427089671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2910 BRIARCLIFFE RD",
"address_2": "SUITE 604-B",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271063176",
"telephone_number": "336-407-6764",
"fax_number": "336-773-0332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2910 BRIARCLIFF ROAD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271063176",
"telephone_number": "336-407-6764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAPES",
"first_name": "KRISTIN",
"middle_name": "ELIZABETH",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-05",
"last_updated": "2016-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "NC",
"license": "673",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "1582323",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "6114757",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "03629",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000520",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.