Kristen Kelly Frederiksen, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

14040-33 Issued in WI

Practice address

4779 S Forest Point Blvd
New Berlin, WI 53151-7476

Phone

(262) 894-4193

NPI assigned

Jun 5, 2023

Last updated

Apr 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Nurse Practitioner

Education

Loyola University of Chicago, Stritch School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkelly349826@direct.myadvocateaurora.org

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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment Care Compare group NPD
• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • St Francis, WI
  • NPI 1003861188
  Medicare reassignment Care Compare group NPD
• Aurora Advanced Healthcare, Inc.

  • Family Medicine Physician
  • Milwaukee, WI
  • NPI 1265629133
  Medicare reassignment NPD
• Aurora Advanced Healthcare Inc

  • Durable Medical Equipment & Medical Supplies
  • Summit, WI
  • NPI 1477186633
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1093409997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4779 S FOREST POINT BLVD",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517476",
            "telephone_number": "262-894-4193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4779 S FOREST POINT BLVD",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517476",
            "telephone_number": "262-894-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERIKSEN",
        "first_name": "KRISTEN",
        "middle_name": "KELLY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-05",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "14040-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100261245",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkelly349826@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1575 N Rivercenter Dr",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532123978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2",
            "affiliation": "N",
            "address_1": "1575 N Rivercenter Dr",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532123978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susan Genthner Floyd, DNP, CRNP, CPNP-AC
• Ellen M Foss, RPH
• Andrea Fox, APRN
• Lanae D Fox, D.D.S.
• Elizabeth Frantal, PA-C
• Thomas Allan Freichels, APRN, BC
• Fresh Coast Dental 2 LLC (Fresh Coast Dental)
• Marlena J Friedrich, R.N.
• Patricia M Friedrich, LPN
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

• Nurse Practitioner in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.