Individual provider Active NPI

Kim Marie Willison, APNP

  • Adult Health Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1225080955
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2608 Issued in WI
Practice address
2105 E Enterprise Ave
Ste 111
Appleton, WI 54913
Phone
(920) 731-6611
Fax
(920) 731-6732
NPI assigned
May 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2608 WI Primary

Addresses

Primary practice location

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913

Mailing address

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913
Phone (920) 731-6611

Other identifiers 1

IdentifierTypeStateIssuer
41265800MedicaidWI

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
I20050901000372 WI Practitioner - Nurse Practitioner 3476585225 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Institute of the Fox Valley S CGroup PAC ID 8628089331, 13 clinicians

Practice addresses (Care Compare)

102 Grand Seasons Dr
Suite 1
Waupaca, WI 54981-8298
Phone (920) 560-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic and Sports Institute of the Fox Valley S C CurrentSince May 1, 2021 Accepting new patients

Locations

2105 E Enterprise Ave
Ste 101
Appleton, WI 54913
Phone (920) 560-1047

2105 E Enterprise Ave
Ste 111
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
#112
Appleton, WI 54913
Phone (920) 731-3111

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
Ste 113
Appleton, WI 54913
Phone (920) 560-1083

212 E Green Bay St
Shawano, WI 54166
Phone (715) 526-5221

102 Grand Seasons Dr
Ste 1
Waupaca, WI 54981
Phone (715) 942-2553

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBJABD

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.

Hospital & facility affiliations 7

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1225080955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "address_2": "STE 111",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54913",
            "telephone_number": "920-731-6611",
            "fax_number": "920-731-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE",
            "address_2": "STE 111",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54913",
            "telephone_number": "920-731-6611",
            "fax_number": "920-731-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLISON",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "2608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41265800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.