Provider Demographics
NPI:1043295603
Name:KRAFT, TERRI LYNN (NP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:KRAFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:NOVITKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:615-454-9850
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:250 MONROE AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2293
Practice Address - Country:US
Practice Address - Phone:877-702-6863
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704154586163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704154586OtherCONTROLLED SUBSTANCE