Individual provider Active NPI

Kristina Nielsen, APNP

  • Family Nurse Practitioner
  • Fond Du Lac, WI
National Provider Identifier
1366206351
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15014-33 Issued in WI
Practice address
430 E Division St
Fond Du Lac, WI 54935
Phone
(920) 926-8200
NPI assigned
Feb 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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 15014-33 WI Primary

Addresses

Primary practice location

430 E Division St
Fond Du Lac, WI 54935

Mailing address

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8200

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
I20240430001206 WI Practitioner - Nurse Practitioner 5092155671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

421 Camelot Dr
Fond Du Lac, WI 54935-8335
Phone (920) 926-8616

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
15014-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Agnesian Healthcare Inc CurrentSince Mar 19, 2024 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients
Agnesian Healthcare Inc CurrentSince Mar 19, 2024 Accepting new patients

Locations

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

421 Camelot Dr
Fond du Lac, WI 54935
Phone (920) 923-7940

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

Interoperability endpoints

  • Direct secure messaging: kkaiser331311@direct-ehr-ssmhc.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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1366206351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-926-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "KRISTINA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "15014-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.