Active NPI
Tilly Burroughs, APNP, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Kenosha, WI
National Provider Identifier
1669109641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 13216-33
- Practice address
- 1010 35TH St
Kenosha, WI 53140-1902 - Phone
- (262) 725-4426
- Fax
- (262) 299-7136
- NPI assigned
- Aug 1, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 13216-33 | WI | Primary |
| Nurse Practitioner | 363L00000X | 13216-33 | WI |
Addresses
Primary practice location
1010 35TH St
Kenosha, WI 53140-1902
Mailing address
1010 35TH St
Kenosha, WI 53140-1902
Phone (262) 725-4426
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Tilly@fpckenosha.com | Direct |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1114 56TH St
Kenosha, WI 53140-3668
Phone (262) 725-4426
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13216-33 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Psychiatric Care, LLC | Psychiatric/Mental Health | Current | Accepting new patients |
Locations
1010 35th St
Kenosha, WI 53140
Phone (262) 652-3500
1114 56th St
Kenosha, WI 53140
Phone (262) 725-4426
Interoperability endpoints
- tilly@fpckenosha.com
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 and National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Kenosha, WI
- NPI 1487178984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742169600000",
"number": "1669109641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 35TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401902",
"telephone_number": "262-725-4426",
"fax_number": "262-299-7136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 35TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401902",
"telephone_number": "262-725-4426",
"fax_number": "262-299-7136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURROUGHS",
"first_name": "TILLY",
"name_prefix": "Mrs.",
"credential": "APNP, PMHNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-01",
"last_updated": "2025-03-17",
"certification_date": "2025-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "WI",
"license": "13216-33",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "13216-33",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Tilly@fpckenosha.com",
"affiliation": "N",
"endpointDescription": "Work e-mail",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "E-mail",
"address_1": "1114 56th St",
"city": "Kenosha",
"state": "WI",
"country_code": "US",
"postal_code": "531403668",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.