Healthcare Provider Details

I. General information

NPI: 1356854194
Provider Name (Legal Business Name): KRISTEN LEIGH ADDINGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN LEIGH FORSTER PA-C

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15717 15 MILE RD
CLINTON TOWNSHIP MI
48035-2101
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-285-3800
  • Fax: 586-285-3818
Mailing address:
  • Phone: 313-874-4806
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: