Kristyn Gregory DO PC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

5101014561 Issued in MI

Legal business name

KRISTYN GREGORY DO PC

Practice address

57327 Van Dyke Rd
Washington, MI 48094-2892

Phone

(586) 203-2020

Fax

(586) 992-1210

NPI assigned

Mar 19, 2007

Organization subpart

No

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

Authorized official

Name

Kristyn Marie Gregory, DO

Title

Owner

Phone

(586) 203-2020

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1710002001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16075 WHITE WATER DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480426183",
            "telephone_number": "810-794-7750",
            "fax_number": "810-794-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57327 VAN DYKE RD",
            "city": "WASHINGTON",
            "state": "MI",
            "postal_code": "480942892",
            "telephone_number": "586-203-2020",
            "fax_number": "586-992-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTYN GREGORY DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "KRISTYN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-203-2020",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101014561",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "5101014561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "2655012874",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Washington, MI
• Providers in Washington, MI by specialty
• Child & Adolescent Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.