Active NPI
Katelyn Recker, RDH
- Dental Hygienist
- Bloomer, WI
National Provider Identifier
1376944686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 10790-016
- Practice address
- 5388 State Highway 64
Bloomer, WI 54724-4788 - Phone
- (715) 933-0065
- NPI assigned
- Sep 6, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 10790-016 | WI | Primary |
Addresses
Primary practice location
5388 State Highway 64
Bloomer, WI 54724-4788
Mailing address
W12949 Lake Dr
Gilman, WI 54433-9369
Phone (715) 314-0540
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10790-016 | WI | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Dental Hygiene Express Inc | Dental Hygienist | Past | Accepting new patients |
| Professional Dental Hygiene Express Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dental Hygienist
- Bloomer, WI
- NPI 1134472285
-
- Public Health or Welfare Agency
- Bloomer, WI
- NPI 1831634401
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409961600000",
"number": "1376944686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W12949 LAKE DR",
"city": "GILMAN",
"state": "WI",
"postal_code": "544339369",
"telephone_number": "715-314-0540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5388 STATE HIGHWAY 64",
"city": "BLOOMER",
"state": "WI",
"postal_code": "547244788",
"telephone_number": "715-933-0065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RECKER",
"first_name": "KATELYN",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-06",
"last_updated": "2014-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "10790-016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.