Active NPI
Kelly A Pickens, APNP
- Nurse Practitioner
- Richland Center, WI
National Provider Identifier
1740281401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 2602
- Practice address
- 301 E 2ND St
Richland Center, WI 53581-1900 - Phone
- (608) 647-6161
- Fax
- (608) 647-3178
- NPI assigned
- Aug 3, 2005
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2602 | WI | Primary |
Addresses
Primary practice location
301 E 2ND St
Richland Center, WI 53581-1900
Mailing address
2917 International LN
PO Box 14017
Madison, WI 53704-3135
Phone (608) 245-3354
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41264700 | Medicaid | WI | |
| 0852480001 | Other | WI | DMERC |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2602 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Take Care Health Wisconsin, S.C | Past | Accepting new patients |
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.
-
- Family Nurse Practitioner
- Milwaukee, WI
- NPI 1730241258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1740281401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2917 INTERNATIONAL LN",
"address_2": "PO BOX 14017",
"city": "MADISON",
"state": "WI",
"postal_code": "537043135",
"telephone_number": "608-245-3354",
"fax_number": "866-903-5812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E 2ND ST",
"city": "RICHLAND CENTER",
"state": "WI",
"postal_code": "535811900",
"telephone_number": "608-647-6161",
"fax_number": "608-647-3178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKENS",
"first_name": "KELLY",
"middle_name": "A",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-03",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "2602",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41264700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0852480001",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richland Center, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.