Individual provider Active NPI

Molly Kidner, FNP-BC

  • Family Nurse Practitioner
  • Traverse City, MI
National Provider Identifier
1083035521
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704183474 Issued in MI
Practice address
4062 W Royal Dr
Traverse City, MI 49684-8965
Phone
(231) 935-0338
NPI assigned
Dec 31, 2013
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704183474 MI Primary

Addresses

Primary practice location

4062 W Royal Dr
Traverse City, MI 49684-8965

Mailing address

4062 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-0338

Other practice location 1

829 N Center Ave Ste 210
Gaylord, MI 49735-1599
Phone (231) 935-0338

Other practice location 2

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20140301000065 MI Practitioner - Nurse Practitioner 5890970479 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kalkaska Memorial Health CenterGroup PAC ID 3577536002, 57 clinicians

Practice addresses (Care Compare)

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704183474MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kalkaska Memorial Health Center Family Current Accepting new patients
Munson Medical Center Current Accepting new patients
Kalkaska Memorial Health Center CurrentSince Oct 28, 2024 Accepting new patients
Munson Medical Center CurrentSince Jan 14, 2014 Accepting new patients
Kalkaska Memorial Health Center Nurse Practitioner CurrentSince Oct 28, 2024 Accepting new patients
Munson Medical Center CurrentSince Jan 14, 2014 Accepting new patients
Munson Medical Group Past Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

3537 W Front St
Ste A
Traverse City, MI 49684
Phone (231) 935-2525

4062 W Royal Dr
Traverse City, MI 49684
Phone (231) 935-0338

Interoperability endpoints

  • Direct secure messaging: mkidner@direct.mhc.net

Organizations & group practices 8

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1388448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1083035521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4062 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4062 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-0338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 N Center Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351599",
            "country_code": "US",
            "telephone_number": "231-935-0338",
            "fax_number": "231-935-0569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "419 S Coral St",
            "address_purpose": "LOCATION",
            "city": "Kalkaska",
            "state": "MI",
            "postal_code": "496462503",
            "country_code": "US",
            "telephone_number": "231-258-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDNER",
        "first_name": "MOLLY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-31",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704183474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.