Active NPI
Michelle Lynne Kunkle, ARNP
- Family Nurse Practitioner
- Waterloo, IA
National Provider Identifier
1376779090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- A099381
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A099381 | Other | IA | LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| A099381 | IA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairlight Medical Center | Past | Accepting new patients | |
| Williston Radiology Consultants PC | Past | Accepting new patients | |
| Annie M. Kontos, P.C. | Past | 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.
-
- Family Medicine Physician
- Waterloo, IA
- NPI 1528248861
-
- Urgent Care Clinic/Center
- Williston, ND
- NPI 1811162811
-
- Specialist
- Williston, ND
- NPI 1942375852
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.