Active NPI
Kelly M Meyer, DO
- Pediatrics Physician
- Neenah, WI
National Provider Identifier
1194709170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0102201356
- Practice address
- 740 Deerwood Ave
Neenah, WI 54956 - Phone
- (920) 751-9600
- NPI assigned
- Dec 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0102201356 | VA | Primary |
Addresses
Primary practice location
740 Deerwood Ave
Neenah, WI 54956
Mailing address
740 Deerwood Ave
Neenah, WI 54956
Phone (920) 751-9600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39739 | Other | VA | OPTIMA HEALTH PROVIDER NO |
| 100864 | Other | VA | ANTHEM PROVIDER NUMBER |
Other names 1
- Kelly M Lynch
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102201356 | VA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194709170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "740 DEERWOOD AVE",
"city": "NEENAH",
"state": "WI",
"postal_code": "54956",
"telephone_number": "920-751-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 DEERWOOD AVE",
"city": "NEENAH",
"state": "WI",
"postal_code": "54956",
"telephone_number": "920-751-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYER",
"first_name": "KELLY",
"middle_name": "M",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VA",
"license": "0102201356",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA HEALTH PROVIDER NO",
"identifier": "39739",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "100864",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "LYNCH",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Neenah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.