Healthcare Provider Details

I. General information

NPI: 1780568857
Provider Name (Legal Business Name): KRISTEN NICHOLE REESER CPRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KRISTEN NICHOLE CARTER

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 WOODLAWN DR
COLUMBIAVILLE MI
48421-9768
US

IV. Provider business mailing address

946 WOODLAWN DR
COLUMBIAVILLE MI
48421-9768
US

V. Phone/Fax

Practice location:
  • Phone: 810-322-0854
  • Fax:
Mailing address:
  • Phone: 810-322-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: