Active NPI
Kristina M Pickett, DO
- Surgery Physician
- Grand Blanc, MI
National Provider Identifier
1932891165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 23121072044
- Practice address
- 1 Genesys Pkwy
Grand Blanc, MI 48439-8065 - Phone
- (810) 606-5000
- NPI assigned
- May 25, 2023
- Last updated
- May 25, 2023
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 23121072044 | MI | Primary |
Addresses
Primary practice location
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Mailing address
1321 Winding Ridge Dr Apt 3B
Grand Blanc, MI 48439-7556
Phone (614) 512-4187
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230713003126 | MI | Order and Referring Only - General Surgery | 2365802949 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23121072044 | MI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684972800000",
"number": "1932891165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 WINDING RIDGE DR APT 3B",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484397556",
"telephone_number": "614-512-4187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GENESYS PKWY",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398065",
"telephone_number": "810-606-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKETT",
"first_name": "KRISTINA",
"middle_name": "M",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-25",
"last_updated": "2023-05-25",
"certification_date": "2023-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "23121072044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
- Physical Therapy Company, PLLC
- Physician Coverage Services (michigan health specialist)
- Physician Coverage Services (michigan health specialist)
- Physiotherapy Associates Inc
- Alexis Lashae Pickett
- Melissa Dawn Pieper, MBA, RD, CSR
- Julie Jordan Pinkston
- Pinnacle Dermatology, S.C.
- Pinnacle Dermatology, S.C.
- Hannah Pintacura
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.