Debra A Kawulok, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11988.1019 Issued in WY

Practice address

304 Coffeen Ave
Ste a
Sheridan, WY 82801-4803

Phone

(307) 674-1744

Fax

(307) 674-1752

NPI assigned

Oct 16, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Debra Ann Radden Former name

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goose Creek Family Practice, P.C.

  • Clinic/Center
  • Sheridan, WY
  • NPI 1134407356
  Medicare reassignment NPD Authorized official
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1013242502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 COFFEEN AVE",
            "address_2": "STE A",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014803",
            "telephone_number": "307-674-1744",
            "fax_number": "307-674-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 COFFEEN AVE",
            "address_2": "STE A",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014803",
            "telephone_number": "307-674-1744",
            "fax_number": "307-674-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWULOK",
        "first_name": "DEBRA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-16",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "11988.1019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "RADDEN",
            "middle_name": "ANN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Dawn Kassian, DPT
• Joseph V Katschke, O.D.
• Katelynn Katz
• Trae Kaufmann, RN
• Brandon M Kavanaugh
• Shelby Kehrwald
• Meagan J. Kekich
• Tanyon Keller
• Brandon Kelley
• Lauren P Kelley, RRT

• Family Nurse Practitioner in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Family Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.