Individual provider Active NPI

Kimberly Ann Stevens, APNP

  • Family Nurse Practitioner
  • Menasha, WI
National Provider Identifier
1467200758
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15343-33 Issued in WI
Practice address
1186 Appleton Rd
Menasha, WI 54952-1906
Phone
(920) 727-8700
Fax
(920) 727-8740
NPI assigned
May 10, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 15343-33 WI Primary

Addresses

Primary practice location

1186 Appleton Rd
Menasha, WI 54952-1906

Mailing address

519 Riverway
Menasha, WI 54952-3430
Phone (850) 565-0060

Other practice location 1

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kstevens456036@ewd.direct.hshs.org Direct St Vincent Hospital-Hospital Sisters-Third Order of St Francis

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240909000296 WI Practitioner - Nurse Practitioner 9133669963

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15343-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Clinic, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Prevea Clinic, Inc. CurrentSince Aug 1, 2024 Accepting new patients

Locations

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

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.

NPI Registry JSON

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1467200758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 RIVERWAY",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549523430",
            "telephone_number": "850-565-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1186 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521906",
            "telephone_number": "920-727-8700",
            "fax_number": "920-727-8740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2502 S Ashland Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543045252",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-10",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "15343-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstevens456036@ewd.direct.hshs.org",
            "affiliation": "Y",
            "affiliationName": "St Vincent Hospital-Hospital Sisters-Third Order of St Francis",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2502 S Ashland Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543045252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.