Healthcare Provider Details

I. General information

NPI: 1750260881
Provider Name (Legal Business Name): KRISTA ANN PELTON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4473 220TH AVE
REED CITY MI
49677-8593
US

IV. Provider business mailing address

301 S CRAPO ST
MT PLEASANT MI
48858-2941
US

V. Phone/Fax

Practice location:
  • Phone: 231-832-2247
  • Fax:
Mailing address:
  • Phone: 989-772-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704307719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: