NPIMap

Individual provider Active NPI

Katie Boerst, FNP

  • Family Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1154067239
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13024-33 Issued in WI
Practice address
W5282 Amy Ave
Appleton, WI 54915-7233
Phone
(920) 358-1900
NPI assigned
May 11, 2022
Reactivated
Aug 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 220741-30 WI
Family Nurse Practitioner 363LF0000X 13024-33 WI Primary

Addresses

Primary practice location

W5282 Amy Ave
Appleton, WI 54915-7233

Mailing address

414 W 5TH St
Appleton, WI 54911-6006
Phone (920) 764-0132

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220817002153 WI Practitioner - Nurse Practitioner 3577946938 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
Telehealth
Offers telehealth services
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

520 W 3Rd St
Kimberly, WI 54136-1300
Phone (920) 788-7680

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
220741-30WIMDRegistered Nurse
13024-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Jul 8, 2022 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Past Accepting new patients

Locations

W5282 Amy Ave
Appleton, WI 54915
Phone (920) 358-1900

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

520 W 3rd St
Kimberly, WI 54136
Phone (920) 788-7680

2005 Midway Rd
Menasha, WI 54952
Phone (920) 380-4812

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • Direct secure messaging: kboerst200008@direct.thedacare.org

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 12

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": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1154067239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 W 5TH ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549116006",
            "telephone_number": "920-764-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W5282 AMY AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549157233",
            "telephone_number": "920-358-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERST",
        "first_name": "KATIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "deactivation_date": "2022-07-08",
        "reactivation_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "220741-30",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "13024-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.