Individual provider Active NPI

Kristen Marie Dessouki, NP

  • Nurse Practitioner
  • Redford, MI
National Provider Identifier
1700508512
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704276440 Issued in MI
Practice address
17190 Lennane
Redford, MI 48240-2130
Phone
(313) 704-2954
NPI assigned
Sep 19, 2022
Last updated
May 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704276440 MI Primary

Addresses

Primary practice location

17190 Lennane
Redford, MI 48240-2130

Mailing address

PO Box 18998
Belfast, ME 04915-4084
Phone (469) 803-3000

Other practice location 1

261 Mack Ave
Detroit, MI 48201-2417
Phone (313) 745-1203

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL URL

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
I20230110000289 MI Practitioner - Nurse Practitioner 1456721463 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
VHS Physicians of Michigan CurrentSince Aug 23, 2020 Accepting new patients
Above & Beyond Urgent Care PLLC CurrentSince Mar 1, 2024 Accepting new patients
HMC Urgent Care Wayne PLLC CurrentSince Mar 1, 2024 Accepting new patients

Locations

261 Mack Ave
Detroit, MI 48201
Phone (313) 745-1100

261 Mack Ave
Ste 210
Detroit, MI 48201
Phone (313) 745-7610

32413 Michigan Ave
Wayne, MI 48184
Phone (313) 663-9000

Interoperability endpoints

  • Direct secure messaging: kristen.dessouki.1@28492.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1700508512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18998",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154084",
            "telephone_number": "469-803-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17190 LENNANE",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482402130",
            "telephone_number": "313-704-2954"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "261 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012417",
            "country_code": "US",
            "telephone_number": "313-745-1203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESSOUKI",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-19",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704276440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "URL",
            "affiliation": "N",
            "address_1": "17190 Lennane",
            "city": "Redford",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482402130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redford, MI

Sources for this page

Verify at the official NPI Registry.