Individual provider Active NPI

Kimberly H. Weekes, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1174639769
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1756-023 Issued in WI
Practice address
5408 W Burleigh St
Milwaukee, WI 53210-1624
Phone
(414) 445-6520
Fax
(414) 445-6875
NPI assigned
Aug 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1756-023 WI Primary

Addresses

Primary practice location

5408 W Burleigh St
Milwaukee, WI 53210-1624

Mailing address

5408 W Burleigh St
Milwaukee, WI 53210-1624
Phone (414) 445-6520

Other identifiers 1

IdentifierTypeStateIssuer
41996800MedicaidWI

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1756WIMDClinical Social Worker
1756-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension SE Wisconsin Hospital, Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1174639769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5408 W BURLEIGH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101624",
            "telephone_number": "414-445-6520",
            "fax_number": "414-445-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5408 W BURLEIGH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101624",
            "telephone_number": "414-445-6520",
            "fax_number": "414-445-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEEKES",
        "first_name": "KIMBERLY",
        "middle_name": "H.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1756-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41996800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.