Kelli Leigh Buterakos

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703116678 Issued in MI

Practice address

18323 East Rd
New Lothrop, MI 48460-9612

Phone

(321) 624-2482

NPI assigned

Dec 27, 2019

Last updated

Dec 27, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1577404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1437798204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18323 EAST RD",
            "city": "NEW LOTHROP",
            "state": "MI",
            "postal_code": "484609612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18323 EAST RD",
            "city": "NEW LOTHROP",
            "state": "MI",
            "postal_code": "484609612",
            "telephone_number": "321-624-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTERAKOS",
        "first_name": "KELLI",
        "middle_name": "LEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703116678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlie Birchmeier
• Jennifer L. Bishop, P.T.A.
• Janice Adria Eickholt-March, LMSW
• Janice Eickholt-March LMSW, Cadc
• Brittney Paige Lang, ATC
• Christopher Carl Maki, DDS
• Carolyn Ann Mora

• Licensed Practical Nurse in New Lothrop, MI
• Providers in New Lothrop, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; 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.