Individual provider Active NPI

Kelly Analiese Richards, FNP

  • Family Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1336433879
Registry record updated Nov 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4397-33 Issued in WI
Practice address
210 W Capitol Dr
Milwaukee, WI 53212-1123
Phone
(414) 906-5306
Fax
(414) 906-4533
NPI assigned
Jun 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2013

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 4397-33 WI Primary

Addresses

Primary practice location

210 W Capitol Dr
Milwaukee, WI 53212-1123

Mailing address

210 W Capitol Dr
Milwaukee, WI 53212-1123
Phone (414) 906-5306

Other identifiers 1

IdentifierTypeStateIssuer
1336433879MedicaidWI

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
I20120626000416 WI Practitioner - Nurse Practitioner 6204091267 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

220 W Capitol Dr
Milwaukee, WI 53212-1185
Phone (414) 727-6320

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4397-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Outreach Community Health Centers, Inc. CurrentSince Jun 4, 2012 Accepting new patients
Outreach Community Health Centers, Inc CurrentSince Jun 4, 2012 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince Mar 1, 2019 Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

210 W Capitol Dr
Glendale, WI 53212

220 W Capitol Dr
Glendale, WI 53212
Phone (414) 964-9018

4601 N 84th St
Milwaukee, WI 53225
Phone (414) 727-6315

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Interoperability endpoints

  • Direct secure messaging: krichards105289@direct.ochin.org

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": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385337600000",
    "number": "1336433879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532121123",
            "telephone_number": "414-906-5306",
            "fax_number": "414-906-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532121123",
            "telephone_number": "414-906-5306",
            "fax_number": "414-906-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDS",
        "first_name": "KELLY",
        "middle_name": "ANALIESE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2013-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "4397-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336433879",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.