Kristin Marie Mortensen-Ward, CPM, LM CPM, LCPM
Individual provider Active NPI Midwife · Fulton, IL
NPI 1396469730 · NPPES record last updated Feb 24, 2025
Key facts
- NPI
- 1396469730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- 295.000022 (IL)
- Practice address
- 14100 Kennedy Rd
Fulton, IL 61252-9619 - Phone
- (309) 507-2420
- NPI assigned
- Sep 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 295.000022 | IL | MD | Midwife |
| CPM0003 | IL | MD | Midwife |
| 528-49 | WI | MD | Midwife |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lay Midwife | 175M00000X | |||
| Midwife | 176B00000X | 528-49 | WI | |
| Midwife | 176B00000X | CPM0003 | IL | |
| Midwife | 176B00000X | 295.000022 | IL | Yes |
Addresses
Primary practice location
14100 Kennedy Rd
Fulton, IL 61252-9619
Mailing address
14100 Kennedy Rd
Fulton, IL 61252-9619
Phone (309) 507-2420
Other providers in Fulton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.