Kelli Jean Frederickson, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

6107-33 Issued in WI

Practice address

2845 Greenbrier Rd
Green Bay, WI 54311-6519

Phone

(920) 288-8300

Fax

(920) 288-8305

NPI assigned

Nov 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Aurora LLCGroup PAC ID 0244130557, 197 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113
• Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kfrederickson56105@direct.myadvocateaurora.org

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.

• Baycare Aurora, LLC

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1255387726
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Aurora Medical Center Bay Area, Inc

  • General Acute Care Hospital
  • Marinette, WI
  • NPI 1043397177
  Care Compare affiliation
• Aurora Medical Center Bay Area, Inc

  dba Aurora Medical Center Bay Area Clinical Medical Laboratory

  • Clinical Medical Laboratory
  • Marinette, WI
  • NPI 1083791115

  Hospital

  Care Compare affiliation
• Aurora Medical Center Bay Area, Inc

  dba Aurora Medical Center Bay Area

  • Land Ambulance
  • Marinette, WI
  • NPI 1427135557

  Hospital

  Care Compare affiliation
• Baycare Aurora, LLC

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1255387726
  Care Compare affiliation

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1659777332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 N BROADWAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116519",
            "telephone_number": "920-288-8300",
            "fax_number": "920-288-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "KELLI",
        "middle_name": "JEAN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-07",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6107-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100041694",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Franz O. Igler, M.D., S.C.
• Kayla Marie Franzluebbers, D.C.
• Catherine B Frazier, PA
• John Frazier, DDS
• Thomas S Fredeen, M.D.
• Jenna L Fredrick, APNP
• Brad M Freeborn, DPT
• Bridget Freeman, MD
• Timothy J Freeman, MD
• Cathy J Freis, NP

• Nurse Practitioner in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.