Individual provider Active NPI

Tilly Burroughs, APNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kenosha, WI
National Provider Identifier
1669109641
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
13216-33 Issued in WI
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

Updated by the provider on Mar 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230502001678 WI Practitioner - Nurse Practitioner 9234594995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Family Psychiatric Care LLCGroup PAC ID 8123385648, 6 clinicians

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

LicenseStateTypeSpecialty
13216-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Psychiatric Care, LLC Psychiatric/Mental Health CurrentSince Mar 23, 2023 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.