Healthcare Provider Details

I. General information

NPI: 1629024799
Provider Name (Legal Business Name): KRISTIN ANN REGAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANN LU AUD

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 ROBINSON RD STE 3
JACKSON MI
49203
US

IV. Provider business mailing address

1410 W GANSON ST
JACKSON MI
49202-4063
US

V. Phone/Fax

Practice location:
  • Phone: 517-962-5063
  • Fax: 517-962-5209
Mailing address:
  • Phone: 517-962-5063
  • Fax: 517-962-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: