Kristin Dezara Fernandez

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502008055 Issued in MI

Practice address

1085 S Linden Rd Ste 100
Flint, MI 48532-3416

Phone

(810) 262-2000

NPI assigned

May 31, 2023

Last updated

May 31, 2023By 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

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": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1699468181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 CHICAGO BLVD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485033472",
            "telephone_number": "810-308-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 S LINDEN RD STE 100",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323416",
            "telephone_number": "810-262-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "KRISTIN",
        "middle_name": "DEZARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502008055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayonna Shanique Ferguson
• Marjorie Lee Ferguson, NP,CS
• Tami A Ferguson
• Erin Elizabeth Ferme, LMSW CAADC ACSW
• David Armando Fernandez, MD
• Liesbeth Glenna Fernandez, RD
• Brittany Ferrell
• Jennifer Ferrier
• Megan Ferrilla
• Cheyenne Lynn Ferris

• Physical Therapy Assistant in Flint, MI
• Providers in Flint, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; 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.