Healthcare Provider Details

I. General information

NPI: 1316058357
Provider Name (Legal Business Name): KRISTEN SORROW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax: 517-205-1540
Mailing address:
  • Phone: 517-205-1594
  • Fax: 517-205-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704216622
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704216622
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN11969
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: