Active NPI
Richard A Kiraly, NP
- Nurse Practitioner
- Wild Rose, WI
National Provider Identifier
1063761013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4965
- Practice address
- 701 Grove Ave
Wild Rose, WI 54984-6901 - Phone
- (920) 622-6017
- NPI assigned
- Sep 6, 2012
- Last updated
- Apr 29, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4965 | WI | Primary |
Addresses
Primary practice location
701 Grove Ave
Wild Rose, WI 54984-6901
Mailing address
701 Grove Ave
Wild Rose, WI 54984-6901
Phone (920) 622-6017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 363L00000X | Medicaid | WI |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4965 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1063761013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 GROVE AVE",
"city": "WILD ROSE",
"state": "WI",
"postal_code": "549846901",
"telephone_number": "920-622-6017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 GROVE AVE",
"city": "WILD ROSE",
"state": "WI",
"postal_code": "549846901",
"telephone_number": "920-622-6017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRALY",
"first_name": "RICHARD",
"middle_name": "A",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-06",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "4965",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "363L00000X",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wild Rose, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.