Kim Wenona White, CNS-BC

Primary specialty

Clinical Nurse SpecialistTaxonomy code 364S00000X

License

209011109 Issued in IL

Practice address

601 James R Thompson Blvd
Building D, Suite 2015
East Saint Louis, IL 62201-1129

Phone

(618) 482-6959

Fax

(618) 482-8311

NPI assigned

Jan 13, 2014

Last updated

Jan 13, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kim Wenona Melcenheimer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Illinois University

  dba Community Nursing Services

  • Clinic/Center
  • E Saint Louis, IL
  • NPI 1306273776
  Authorized official Same address or phone
• Southern Illinois Regional Wellness Center

  • Federally Qualified Health Center (FQHC)
  • East Saint Louis, IL
  • NPI 1336258540
  NPD (past)

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

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389571200000",
    "number": "1427470368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JAMES R THOMPSON BLVD",
            "address_2": "BUILDING D, SUITE 2015",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622011129",
            "telephone_number": "618-482-6959",
            "fax_number": "618-482-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JAMES R THOMPSON BLVD",
            "address_2": "BUILDING D, SUITE 2015",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622011129",
            "telephone_number": "618-482-6959",
            "fax_number": "618-482-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "KIM",
        "middle_name": "WENONA",
        "name_prefix": "Ms.",
        "credential": "CNS-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "IL",
            "license": "209011109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "MELCENHEIMER",
            "middle_name": "WENONA",
            "prefix": "MS.",
            "credential": "CNS-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Virgil L Calvert Care Center
• W-T Services Inc.
• Margi Lynn Wagner-Farley
• Walgreen Co (Walgreens #04602)
• Ranita A Walker, CPT
• Lisa M White
• Janet C Whitworth, RN, FNP-BC, DNP
• Akemie Edna Williams Gray, M.D.
• Kevin Scott Worster, RPH
• Millie Wright, MSW

• Clinical Nurse Specialist in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.

Verify at the official NPI Registry.