{
"Npi": {
"NPI": "1003342551",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KUNNEN",
"FirstName": "KATHERINE",
"MiddleName": "E.",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DNP, FNP-C, PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PRUSS",
"OtherFirstName": "KATHERINE",
"OtherMiddleName": "ELIZABETH EUNJEE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DNP, FNP-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "107 ALTEN AVE NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49503-3703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-223-4562",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3300 36TH ST SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND RAPIDS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49512-2810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-942-2110",
"PracticeLocationAddressFaxNumber": "616-942-9548",
"EnumerationDate": "05/03/2017",
"LastUpdateDate": "08/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "4704274169",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "4704274169",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}