Individual provider Active NPI

Lori Deprez King, RN, APNP

  • Nurse Practitioner
  • Kaukauna, WI
National Provider Identifier
1548210925
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
423 Issued in WI
Practice address
305 E 12TH St
Kaukauna, WI 54130-2865
Phone
(920) 766-4656
Fax
(920) 766-4659
NPI assigned
May 10, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 423 WI Primary

Addresses

Primary practice location

305 E 12TH St
Kaukauna, WI 54130-2865

Mailing address

305 E 12TH St
Kaukauna, WI 54130-2865
Phone (920) 766-4656

Other identifiers 1

IdentifierTypeStateIssuer
43819300MedicaidWI

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
I20100602000813 WI Practitioner - Nurse Practitioner 8123157005 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
423WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kaukauna Clinic, S.C. CurrentSince Nov 1, 2001 Accepting new patients

Locations

305 E 12th St
Kaukauna, WI 54130
Phone (920) 731-3111

Interoperability endpoints

  • Direct secure messaging: lking15996@direct.thedacare.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1548210925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E 12TH ST",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541302865",
            "telephone_number": "920-766-4656",
            "fax_number": "920-766-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E 12TH ST",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541302865",
            "telephone_number": "920-766-4656",
            "fax_number": "920-766-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "LORI",
        "middle_name": "DEPREZ",
        "name_prefix": "Ms.",
        "credential": "RN, APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43819300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kaukauna, WI

Sources for this page

Verify at the official NPI Registry.