Kelly Marissa Burri, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704247029 Issued in MI

Practice address

664 Michigan Ave
Holland, MI 49423-4944

Phone

(616) 392-5973

Fax

(616) 392-1646

NPI assigned

Oct 16, 2014

Last updated

Jul 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Kelly Marissa Vander Ploeg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dawm, PLC

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1932132446
  NPD (past)

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

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1528462702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "664 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234944",
            "telephone_number": "616-392-5973",
            "fax_number": "616-392-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "664 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234944",
            "telephone_number": "616-392-5973",
            "fax_number": "616-392-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRI",
        "first_name": "KELLY",
        "middle_name": "MARISSA",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-16",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704247029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "VANDER PLOEG",
            "middle_name": "MARISSA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Burke, PTA
• Brad M Burke, CNA
• Melissa Renee Burke
• Timothy Burke, PHARMD
• Thomas D Burns, MD
• Kaitlin Rosemary Busch, MA, CCC-SLP
• Matthew Warren Bush, MA, LLP
• Taryn Bushong
• Natalya Busscher
• James Lee Bussis, RPH

• Family Nurse Practitioner in Holland, MI
• Providers in Holland, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.