Active NPI
Kelley E Farnsworth, PA-C
- Surgical Physician Assistant
- Milwaukee, WI
National Provider Identifier
1720026339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1051-023
- Practice address
- 960 N 12TH St
Suite 1800
Milwaukee, WI 53233-1306 - Phone
- (414) 278-9000
- Fax
- (414) 278-9005
- NPI assigned
- Jun 4, 2006
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1051-023 | WI | Primary |
Addresses
Primary practice location
960 N 12TH St
Suite 1800
Milwaukee, WI 53233-1306
Mailing address
960 N 12TH St
Suite 1800
Milwaukee, WI 53233-1306
Phone (414) 278-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42982600 | Medicaid | WI |
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 |
|---|---|---|---|
| 1051 | WI | MD | Genetic Counselor (M.S.) |
| 1051-023 | WI | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193184000000",
"number": "1720026339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 N 12TH ST",
"address_2": "SUITE 1800",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532331306",
"telephone_number": "414-278-9000",
"fax_number": "414-278-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 N 12TH ST",
"address_2": "SUITE 1800",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532331306",
"telephone_number": "414-278-9000",
"fax_number": "414-278-9005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARNSWORTH",
"first_name": "KELLEY",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-04",
"last_updated": "2007-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WI",
"license": "1051-023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42982600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.