Active NPI
Alycea Noel Pupp, APNP
- Family Nurse Practitioner
- Weston, WI
National Provider Identifier
1508264839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 6153
- Practice address
- 5302 Fuller St
Weston, WI 54476-3101 - Phone
- (715) 219-8950
- Fax
- (715) 692-0246
- NPI assigned
- Dec 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 Medicine Physician | 207Q00000X | 6153-33 | WI | |
| Family Nurse Practitioner | 363LF0000X | 6153 | WI | Primary |
Addresses
Primary practice location
5302 Fuller St
Weston, WI 54476-3101
Mailing address
5302 Fuller St
Weston, WI 54476-3101
Phone (715) 219-8950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160594 | Other | WI | RN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Feb 8, 2022 through Feb 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6153-33 | WI | MD | Family Medicine Physician |
| 6153 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648339200000",
"number": "1508264839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5302 FULLER ST",
"city": "WESTON",
"state": "WI",
"postal_code": "544763101",
"telephone_number": "715-219-8950",
"fax_number": "715-692-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5302 FULLER ST",
"city": "WESTON",
"state": "WI",
"postal_code": "544763101",
"telephone_number": "715-219-8950",
"fax_number": "715-692-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUPP",
"first_name": "ALYCEA",
"middle_name": "NOEL",
"credential": "APNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-19",
"last_updated": "2022-03-27",
"certification_date": "2022-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "6153-33",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "6153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "160594",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Weston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.