Active NPI
Kerri-Ann Graham Michaux, D.M.D.
- Dentist
- Ormond Beach, FL
National Provider Identifier
1821062019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN16350
- Practice address
- 802 Sterthaus Dr Ste a
Ormond Beach, FL 32174-5132 - Phone
- (386) 868-4483
- Fax
- (321) 445-5364
- NPI assigned
- Feb 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN16350 | FL | Primary |
Addresses
Primary practice location
802 Sterthaus Dr Ste a
Ormond Beach, FL 32174-5132
Mailing address
802 Sterthaus Dr Ste a
Ormond Beach, FL 32174-5117
Phone (850) 227-4628
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 075554100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 21, 2022 through Sep 21, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN16350 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1821062019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 STERTHAUS DR STE A",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321745117",
"telephone_number": "850-227-4628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 STERTHAUS DR STE A",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321745132",
"telephone_number": "386-868-4483",
"fax_number": "321-445-5364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM MICHAUX",
"first_name": "KERRI-ANN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-14",
"last_updated": "2022-09-23",
"certification_date": "2022-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN16350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "075554100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ormond Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.