Active NPI
Kelly Everden, CPNP
- Pediatric Nurse Practitioner
- Pontiac, MI
National Provider Identifier
1629141999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4704213499
- Practice address
- 1051 Arlene Ave
Pontiac, MI 48340-2904 - Phone
- (248) 451-7365
- Fax
- (248) 451-7370
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704213499 | MI | Primary |
Addresses
Primary practice location
1051 Arlene Ave
Pontiac, MI 48340-2904
Mailing address
46 N Saginaw St
Oakland Primary Health Services
Pontiac, MI 48342-2155
Phone (248) 322-6747
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
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704213499 | MI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1629141999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 N SAGINAW ST",
"address_2": "OAKLAND PRIMARY HEALTH SERVICES",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483422155",
"telephone_number": "248-322-6747",
"fax_number": "248-322-5787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 ARLENE AVE",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483402904",
"telephone_number": "248-451-7365",
"fax_number": "248-451-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVERDEN",
"first_name": "KELLY",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MI",
"license": "4704213499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.