Individual provider Active NPI

Jessica Hutchins

  • Nurse Practitioner
  • Brookfield, WI
National Provider Identifier
1609501345
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
112093-33 Issued in WI
Practice address
19005 W Capitol Dr Ste 130
Brookfield, WI 53045-2705
Phone
(262) 510-7462
NPI assigned
Jul 18, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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 112093-33 WI Primary

Addresses

Primary practice location

19005 W Capitol Dr Ste 130
Brookfield, WI 53045-2705

Mailing address

2416 S 52ND St
West Allis, WI 53219-2384
Phone (262) 510-7462

Other identifiers 1

IdentifierTypeStateIssuer
12093-33OtherWIMEDICAL SPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@lunamedspawi.com

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
112093-33WIMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1609501345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 S 52ND ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532192384",
            "telephone_number": "262-510-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19005 W CAPITOL DR STE 130",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452705",
            "telephone_number": "262-510-7462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTCHINS",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-18",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "112093-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL SPA",
            "identifier": "12093-33",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@lunamedspawi.com",
            "affiliation": "N",
            "address_1": "19005 W Capitol Dr Ste 130",
            "city": "Brookfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530452705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.