Individual provider Active NPI

Christina Renee Richard

  • Family Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1437907938
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704300157 Issued in MI
Practice address
3646 Mount Elliott St
Detroit, MI 48207-2311
Phone
(248) 234-1079
NPI assigned
May 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704300157 MI Primary
Registered Nurse 163W00000X 4704300157 MI

Addresses

Primary practice location

3646 Mount Elliott St
Detroit, MI 48207-2311

Mailing address

6309 Mack Ave
Detroit, MI 48207-2302
Phone (248) 234-1079

Other practice location 1

6309 Mack Ave
Detroit, MI 48207-2302
Phone (248) 234-1079

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
I20251103000783 MI Practitioner - Nurse Practitioner 6406345057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

290 Town Ctr Dr
Suite 400
Dearborn, MI 48126

290 Town Ctr Dr
Suite 400
Dearborn, MI 48126-2765

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704300157MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Team Mental Health Services Inc. CurrentSince Aug 21, 2025 Accepting new patients
Team Wellness Center CurrentSince Aug 21, 2025 Accepting new patients
Team Mental Health Services Past Accepting new patients

Locations

290 Town Center Dr
Ste 400
Dearborn, MI 48126
Phone (248) 763-5289

6309 Mack Ave
Detroit, MI 48207
Phone (313) 331-3435

3646 Mount Elliott St
Detroit, MI 48207
Phone (313) 626-2400

2925 Russell St
Detroit, MI 48207
Phone (313) 462-4714

14799 Dix Toledo Rd
Southgate, MI 48195
Phone (888) 813-8326

Organizations & group practices 3

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": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1437907938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6309 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482072302",
            "telephone_number": "248-234-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 MOUNT ELLIOTT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482072311",
            "telephone_number": "248-234-1079"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6309 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482072302",
            "country_code": "US",
            "telephone_number": "248-234-1079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARD",
        "first_name": "CHRISTINA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704300157",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704300157",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.