Alicia Classens, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704230080 Issued in MI

Practice address

5024 N Royal Dr
Kids Creek Children's Clinic
Traverse City, MI 49684-9230

Phone

(231) 935-0555

Fax

(231) 935-0562

NPI assigned

Dec 4, 2006

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: alicia.classens@kccc.eclinicaldirectplus.com

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390521600000",
    "number": "1710045661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3129 SILVER HILLS LN",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "address_2": "KIDS CREEK CHILDREN'S CLINIC",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLASSENS",
        "first_name": "ALICIA",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2014-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704230080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Jeanne Clark, MD
• Kristi M Clark, P.T.A.
• Madeline Clark, LLMSW
• Shawn Andrew Clark
• Brooke Cheyenne Clarke, LLMSW
• Bevin Clayton, DO
• Kathleen Clayton
• Kevin J Clayton, D.O
• Jody Lyn Claytor, RN
• Clear Path Counseling Services LLC.

• Pediatric Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.