Active NPI
Katrina Mavis Coburn, RDH
- Dental Hygienist
- Jackson, MI
National Provider Identifier
1710344270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902013530
- Practice address
- 505 N Jackson St
Jackson, MI 49201-1266 - Phone
- (517) 748-5500
- NPI assigned
- Jan 28, 2016
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902013530 | MI | Primary |
Addresses
Primary practice location
505 N Jackson St
Jackson, MI 49201-1266
Mailing address
505 N Jackson St
Jackson, MI 49201-1266
Phone (517) 748-5500
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kcoburn444895@direct.hfhs.org | Henry Ford Health System |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2902013530 | MI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616457600000",
"number": "1710344270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 N JACKSON ST",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011266",
"telephone_number": "517-748-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 N JACKSON ST",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011266",
"telephone_number": "517-748-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "KATRINA",
"middle_name": "MAVIS",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-28",
"last_updated": "2021-03-23",
"certification_date": "2021-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902013530",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kcoburn444895@direct.hfhs.org",
"affiliation": "Y",
"affiliationName": "Henry Ford Health System",
"address_1": "2799 W Grand Blvd",
"city": "Detroit",
"state": "MI",
"country_code": "US",
"postal_code": "482022608",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.