Individual provider Active NPI

Kayla Nicole Bodart, NP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1104500396
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
13872 Issued in WI
Practice address
2000 E Milestone Dr
Appleton, WI 54913-6701
Phone
(920) 731-8131
NPI assigned
Jun 9, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 13872 WI Primary

Addresses

Primary practice location

2000 E Milestone Dr
Appleton, WI 54913-6701

Mailing address

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Other practice location 1

2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone (920) 288-8280

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230922001487 WI Practitioner - Nurse Practitioner 8628422706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Surgical Associates LTDGroup PAC ID 7911971296, 35 clinicians

Practice addresses (Care Compare)

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Hospital & facility affiliations

  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160
  • Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13872WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Valley Surgical Associates LTD CurrentSince Sep 8, 2025 Accepting new patients
Baycare Aurora, LLC CurrentSince Aug 1, 2023 Accepting new patients

Locations

2000 E Milestone Dr
Appleton, WI 54913
Phone (920) 358-1729

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1104500396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2845 Greenbrier Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116519",
            "country_code": "US",
            "telephone_number": "920-288-8280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODART",
        "first_name": "KAYLA",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-09",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "13872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.