Healthcare Provider Details

I. General information

NPI: 1114470036
Provider Name (Legal Business Name): KRISTAL RICHARDSON-AUBREY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

IV. Provider business mailing address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-7600
  • Fax: 885-480-9150
Mailing address:
  • Phone: 517-374-7600
  • Fax: 885-480-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704273188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: