MR. KIPP EDWARD RUSTENHOLTZ (NPI# 1114193356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114193356 |
| Entity Type | Individual |
| Full Name | MR. KIPP EDWARD RUSTENHOLTZ |
| Credential | PA-C |
| Practice Address |
1881 W Grand River Ave Okemos MI 48864-1840 |
| Mailing Address |
1147 Teakwood Cir Haslett MI 48840-9734 |
| Practice Telephone | 5173392100 |
| Practice Fax Number | 5173394620 |
| Mailing Telephone | 5173390188 |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2018-01-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1881 W GRAND RIVER AVE |
| City | OKEMOS |
| State | MI |
| Zip Code | 48864-1840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346283074 | Arthur J Ronan | Family Medicine | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2006-06-13 |
| 1831744457 | Kyle A Cook | Nurse Practitioner | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2019-08-09 |
| 1396301719 | Grand River Family Care, PC | Family Medicine | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2019-05-10 |
| 1548755051 | Sara-bethany Weir | Family Medicine | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2018-06-27 |
| 1447676283 | Bosworth Urgent Care, PC | Family Medicine | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2014-03-17 |
| 1275746091 | Bosworth Urgent Care PC | Non-Pharmacy Dispensing Site | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2007-05-08 |
| 1063440592 | Quinn M. Bosworth | Family Medicine | 1881 W Grand River Ave, Okemos, MI 48864-1840 | 2006-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972066348 | Jan J Stokosa | Prosthetic/Orthotic Supplier | 2145 University Park Drive, Suite 100, Okemos, MI 48864 | 2019-04-11 |
| 1194284067 | Bryan R Salminen | Counselor | 2127 University Drive Suite 300, Okemos, MI 48864 | 2019-03-19 |
| 1639678600 | Paula Veronica Yevilaf Neira | Behavior Technician | 3887 Okemos Rd Suite A1, Okemos, MI 48864 | 2018-02-06 |
| 1306364690 | Sally Ann Purdy | Social Worker | 3493 Woods Edge Dr., Suite #103, Okemos, MI 48864 | 2017-09-06 |
| 1952824609 | Victoria Marie Hopper | Behavior Technician | 3887 Okemos Rd., Suite #a1, Okemos, MI 48864 | 2017-07-24 |
| 1134653306 | Kayleigh Delaney | Dietitian, Registered | 5050 Marsh Road, Suite 5, Okemos, MI 48864 | 2017-04-14 |
| 1922544402 | Elsabeth Engeda | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4464 Hickory Drive, Okemos, MI 48864 | 2017-01-09 |
| 1104373752 | Joslyn Fraidenburg | Registered Nurse | 2322 Knod Hill Dr, Apt 14, Okemos, MI 48864 | 2016-09-01 |
| 1851748966 | Doug Derdowski | Social Worker | 4123 Okemos Road, Eastbrook Plaza, Okemos, MI 48864 | 2016-05-18 |
| 1437505971 | Jessica Lynn Reslock | Occupational Therapist | 2378 Woodlake Dr. Suite 280, Children's Therapy Corner, Okemos, MI 48864 | 2016-05-13 |
| Find all providers in zip 48864 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740412055 | Adam Francis Montero | Physician Assistant | 2090 Jolly Rd Ste 150, Okemos, MI 48864-6036 | 2009-08-20 |
| 1144326737 | Vida Hb Klott | Physician Assistant | 2205 Jolly Rd Ste B, Okemos, MI 48864-3983 | 2006-09-15 |
| 1407951015 | Katherine E Young | Physician Assistant | 2270 Jolly Oak Rd Ste 1, Okemos, MI 48864-6932 | 2006-09-14 |
| 1922605120 | Katie Guo Zhong | Physician Assistant | 3413 Woods Edge, Okemos, MI 48864-5901 | 2020-10-01 |
| 1497303440 | Marisa Parker Yellin | Physician Assistant | 2090 Jolly Rd Ste 150, Okemos, MI 48864-6036 | 2019-09-03 |
| 1730677238 | Jacob Mark Clapper | Physician Assistant | 2090 Jolly Rd, Okemos, MI 48864-3996 | 2018-04-30 |
| 1568961217 | Rachael Elizabeth Farrell | Physician Assistant | 3413 Woods Edge, Okemos, MI 48864-5901 | 2018-02-08 |
| 1629588108 | Jessie Jean Mcwaters | Physician Assistant | 2134 Hampton Pl, Okemos, MI 48864-3691 | 2017-10-10 |
| 1720445810 | Troy C Thielen | Physician Assistant | 2270 Jolly Oak Rd, Suite 1, Okemos, MI 48864-3542 | 2016-01-21 |
| 1205204898 | Elizabeth Mccomb | Physician Assistant | 2134 Hampton Pl, Okemos, MI 48864-3691 | 2015-09-13 |
| Find all providers in OKEMOS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.