Individual provider Active NPI

Karen J Stevens, PA

  • Physician Assistant
  • Kenosha, WI
National Provider Identifier
1750362208
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
697023 Issued in WI
Practice address
7401 104TH Ave
Suite 110
Kenosha, WI 53142-7845
Phone
(262) 764-5595
Fax
(262) 764-9314
NPI assigned
Nov 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 697023 WI Primary

Addresses

Primary practice location

7401 104TH Ave
Suite 110
Kenosha, WI 53142-7845

Mailing address

7401 104TH Ave
Suite 110
Kenosha, WI 53142-7845
Phone (262) 764-5595

Other identifiers 1

IdentifierTypeStateIssuer
42941600MedicaidWI

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

LicenseStateTypeSpecialty
69723WIMDPsychiatry Physician
697023WIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: karen.stevens.p1@direct.comportho.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1750362208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 104TH AVE",
            "address_2": "SUITE 110",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427845",
            "telephone_number": "262-764-5595",
            "fax_number": "262-764-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 104TH AVE",
            "address_2": "SUITE 110",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427845",
            "telephone_number": "262-764-5595",
            "fax_number": "262-764-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KAREN",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-10",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "697023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42941600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "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 Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.