Kristen Bourgon, MSN, AGPCNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704277091 Issued in MI

Practice address

21650 W 11 Mile Rd Ste 202
Southfield, MI 48076-3777

Phone

(248) 327-6196

Fax

(248) 327-6356

NPI assigned

Jan 30, 2017

Last updated

Mar 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

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.

• Greenfield and 9 Mile Medical Center PLLC

  dba American Medical Center

  • Family Medicine Physician
  • Oak Park, MI
  • NPI 1265874945
  Medicare reassignment NPD
• Integrated Visiting Physician Solutions PC

  • Multi-Specialty Clinic/Center
  • Southfield, MI
  • NPI 1891109641
  Medicare reassignment NPD
• Traveling Physician Services PC

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1366337826

  Nurse Practitioner

  Medicare reassignment NPD
• Greenfield and 9 Mile Medical Center PLLC

  dba American Medical Center

  • Clinical Medical Laboratory
  • Southfield, MI
  • NPI 1598279804
  NPD
• Integrated Physician Solutions PC

  • Home Health Agency
  • Southfield, MI
  • NPI 1992110662
  NPD (past)
• Labaza Eyecare, P.C.

  • Optometrist
  • Rochester, MI
  • NPI 1619184850
  NPD (past)

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1851838809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20075 NORTHVILLE PLACE DR",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481672984",
            "telephone_number": "248-672-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21650 W 11 MILE RD STE 202",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480763777",
            "telephone_number": "248-327-6196",
            "fax_number": "248-327-6356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "236 Constitution St",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481886719",
            "country_code": "US",
            "telephone_number": "248-672-2271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURGON",
        "first_name": "KRISTEN",
        "credential": "MSN, AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-30",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704277091",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704277091",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704277091",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704277091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arthur I Bouier Jr., DO
• Tamer Nady Boules, M.D.
• Austyn Lynnell Boulware
• Jeffrey Dean Bounsall, CRNA
• Kellie Bouren
• Anthony Edward Boutt, MD
• Angel Bowen
• Anthony Darrell Bowens, MA, LLPC
• Bower Enterprises II (ExpertCare)
• Evan Bowles, DPM

• Family Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.