Individual provider Active NPI

Michelle Lynne Kunkle, ARNP

  • Family Nurse Practitioner
  • Waterloo, IA
National Provider Identifier
1376779090
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A099381 Issued in IA
Practice address
305 E San Marnan Dr
Waterloo, IA 50702-5837
Phone
(319) 235-3158
Fax
(319) 235-9836
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A099381 IA Primary
Family Nurse Practitioner 363LF0000X R38041 ND

Addresses

Primary practice location

305 E San Marnan Dr
Waterloo, IA 50702-5837

Mailing address

305 E San Marnan Dr
Waterloo, IA 50702-5837
Phone (319) 235-3158

Other identifiers 1

IdentifierTypeStateIssuer
A099381OtherIALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A099381IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairlight Medical Center Past Accepting new patients
Williston Radiology Consultants PC Past Accepting new patients
Annie M. Kontos, P.C. PastSince Oct 1, 2001 Accepting new patients

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": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1376779090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E SAN MARNAN DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025837",
            "telephone_number": "319-235-3158",
            "fax_number": "319-235-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E SAN MARNAN DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025837",
            "telephone_number": "319-235-3158",
            "fax_number": "319-235-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNKLE",
        "first_name": "MICHELLE",
        "middle_name": "LYNNE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A099381",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R38041",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A099381",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.