Individual provider Active NPI

Krystina L Kienast, FNP-BC

  • Family Nurse Practitioner
  • Wauwatosa, WI
National Provider Identifier
1255839338
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017032701 Issued in WI
Practice address
1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone
(414) 955-5990
NPI assigned
Jan 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2017032701 WI Primary

Addresses

Primary practice location

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462

Mailing address

343 Evergreen LN
Pewaukee, WI 53072-2403
Phone (262) 719-0519

Other names 1

  • Krystina L Koepp Former name

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
I20180301000783 WI Practitioner - Nurse Practitioner 6406117787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone (414) 955-5990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8240WIMDPharmacist
2017032701WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jan 20, 2018 Accepting new patients
The Medical College of Wisconsin, Inc. Current Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jan 20, 2018 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W129N7055 Northfield Dr
Menomonee Falls, WI 53051
Phone (262) 251-5305

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: kkienast239174@direct.froedtert.com

Organizations & group practices 3

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": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516752000000",
    "number": "1255839338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 EVERGREEN LN",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722403",
            "telephone_number": "262-719-0519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263462",
            "telephone_number": "414-955-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIENAST",
        "first_name": "KRYSTINA",
        "middle_name": "L",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "2017032701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTINA",
            "last_name": "KOEPP",
            "middle_name": "L",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.