Micky Kammerer, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95024009 Issued in CA

Practice address

777 S. Ham Lane Ste M
Lodi, CA 95242

Phone

(209) 336-9339

Fax

(209) 224-5921

NPI assigned

Jan 24, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1235845181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 S. HAM LANE STE M",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95242",
            "telephone_number": "209-336-9339",
            "fax_number": "209-224-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 S. HAM LANE STE M",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95242",
            "telephone_number": "209-336-9339",
            "fax_number": "209-224-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMMERER",
        "first_name": "MICKY",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-24",
        "last_updated": "2024-03-07",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95024009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "DirectAccess",
            "affiliation": "N",
            "endpointDescription": "encrypted health information",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "310 S Crescent Ave Ste B",
            "city": "Lodi",
            "state": "CA",
            "country_code": "US",
            "postal_code": "952403933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nurse Practitioner in Lodi, CA
• Providers in Lodi, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.