Nicole Kelly

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2340-19 Issued in WI

Practice address

35 N 28TH St
Superior, WI 54880-5557

Phone

(715) 392-3300

NPI assigned

Jul 17, 2015

Last updated

Jul 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1336523562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4038 MUNGER SHAW RD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557209255",
            "telephone_number": "218-590-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 N 28TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805557",
            "telephone_number": "715-392-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2340-19",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A1718",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ben Christian Kasper, ATC
• Travis Joseph Kasper, MD
• Daniel Michael Kearns
• Karsyn Lynn Keepers
• Deanna Sue Kelly, PTA
• Stacy Ann Kennelly, MA PT
• Tristan Kerfeld
• Jason Kerska, PHARM. D
• Jon M Kiehl, HIS
• Kim Lagro Counseling Services,LLC

• Physical Therapy Assistant in Superior, WI
• Providers in Superior, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.