Individual provider Active NPI

Jessica Kempke

  • Counselor
  • Muskegon, MI
National Provider Identifier
1508103060
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
Nelson Elementary
550 W Grand Avenue
Muskegon, MI 49441-2336
Phone
(231) 733-6680
NPI assigned
Jan 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401012439 MI
Counselor 101Y00000X Primary

Addresses

Primary practice location

Nelson Elementary
550 W Grand Avenue
Muskegon, MI 49441-2336

Mailing address

205 Grove St
Ironmen Health Center
Mancelona, MI 49659-8018
Phone (231) 587-9840

Other practice location 1

205 Grove St
Ironmen Health Center
Mancelona, MI 49659-8018
Phone (231) 587-9840

Other identifiers 1

IdentifierTypeStateIssuer
1508103060MedicaidMI

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6401012439MIMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1508103060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 GROVE ST",
            "address_2": "IRONMEN HEALTH CENTER",
            "city": "MANCELONA",
            "state": "MI",
            "postal_code": "496598018",
            "telephone_number": "231-587-9840",
            "fax_number": "231-587-9846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NELSON ELEMENTARY",
            "address_2": "550 W GRAND AVENUE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494412336",
            "telephone_number": "231-733-6680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Grove St",
            "address_2": "Ironmen Health Center",
            "address_purpose": "LOCATION",
            "city": "Mancelona",
            "state": "MI",
            "postal_code": "496598018",
            "country_code": "US",
            "telephone_number": "231-587-9840",
            "fax_number": "231-587-9846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEMPKE",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-03",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401012439",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508103060",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; 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.