NPIMap

Individual provider Active NPI

Kenna Marie Willey, PA-C

  • Physician Assistant
  • Norwalk, IA
National Provider Identifier
1063642270
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002012 Issued in IA
Practice address
801 Colonial Cir
Norwalk, IA 50211-9626
Phone
(515) 285-3200
Fax
(515) 285-3232
NPI assigned
Jul 22, 2009
Last updated
Jul 1, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002012 IA Primary
Medical Physician Assistant 363AM0700X 002012 IA

Addresses

Primary practice location

801 Colonial Cir
Norwalk, IA 50211-9626

Mailing address

801 Colonial Cir
Norwalk, IA 50211-9626
Phone (515) 285-3200

Other names 1

  • Kenna Marie Wheeldon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Iowa Hospital Corporation Past Accepting new patients
Brian J. Heineman, D.O. Past Accepting new patients
Marengo Memorial Hospital Physician Assistant Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1063642270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 COLONIAL CIR",
            "city": "NORWALK",
            "state": "IA",
            "postal_code": "502119626",
            "telephone_number": "515-285-3200",
            "fax_number": "515-285-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 COLONIAL CIR",
            "city": "NORWALK",
            "state": "IA",
            "postal_code": "502119626",
            "telephone_number": "515-285-3200",
            "fax_number": "515-285-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEY",
        "first_name": "KENNA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-22",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002012",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "002012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNA",
            "last_name": "WHEELDON",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Norwalk, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.