Active NPI
Kailene L Devries
- Physician Assistant
- Sun Prairie, WI
National Provider Identifier
1609315159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3966-023
- Practice address
- 10 Tower Dr
Sun Prairie, WI 53590-1239 - Phone
- (608) 825-3008
- Fax
- (608) 825-3676
- NPI assigned
- Feb 16, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3966-023 | WI | Primary |
Addresses
Primary practice location
10 Tower Dr
Sun Prairie, WI 53590-1239
Mailing address
10 Tower Dr
Sun Prairie, WI 53590-1239
Phone (608) 825-3008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3966-023 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1609315159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 TOWER DR",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901239",
"telephone_number": "608-825-3008",
"fax_number": "608-825-3676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 TOWER DR",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535901239",
"telephone_number": "608-825-3008",
"fax_number": "608-825-3676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVRIES",
"first_name": "KAILENE",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-16",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "3966-023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun Prairie, WI
- Dean Retail Services, Inc. (SSM Health Davis Duehr Dean Eye Care - Sun Prairie)
- Deerwood Orthodontics, LLC (Deerwood Orthodontics Sun Prairie)
- Stephanie Gloria Deis
- Christina M Delany-Richardson, MD
- Dentistry of Wisconsin
- Joshua James Diamond, PHARM D.
- Jessica Diaz, RDH
- Ryan Dilley, PHARMD
- Alise Dobrot, RDN, LDN, LMT
- Kelsey Dorgan, LPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.