Dezari M Dykstra, RN-MSN,FNP, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5964-33 Issued in WI

Practice address

2514 S 102ND St Ste 160
West Allis, WI 53227-2142

Phone

(434) 255-0300

NPI assigned

Nov 29, 2006

Last updated

Apr 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dezari.dykstra.1@32913.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Brookfield, WI
  • NPI 1659484657
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  WI

  Medicare reassignment
• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • West Allis, WI
  • NPI 1619594702
  NPD
• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1225105786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639295 DEPT 93394",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639295",
            "telephone_number": "248-266-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 S 102ND ST STE 160",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272142",
            "telephone_number": "434-255-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1746 Executive Dr.",
            "address_purpose": "LOCATION",
            "city": "Oconomowoc",
            "state": "WI",
            "postal_code": "530664830",
            "country_code": "US",
            "telephone_number": "262-569-5515 x2780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "DEZARI",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "RN-MSN,FNP, APNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "5964-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "148986-030",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39877800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Dugan, DMD
• Jennifer L. Dumke, NP
• Mary Dunkin, MD
• Jean Marie Dunn, RN
• Janet R Durham, MD
• Dynamic Medical Equipment, LLC
• Candace Dziedzic
• Easter Seals Southeast Wisconsin
• William Raul Echevarria, LPC-IT; SAC-IT, MS
• Kenneth G Edington II, DC

• Family Nurse Practitioner in West Allis, WI
• Providers in West Allis, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.