Individual provider Active NPI

Kathryn Ann Fricke, RN

  • Home Health Registered Nurse
  • Wyoming, MI
National Provider Identifier
1760988752
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
4704198105 Issued in MI
Practice address
1853 R W Berends Dr SW
Wyoming, MI 49519-4955
Phone
(616) 534-9300
NPI assigned
Mar 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X 4704198105 MI Primary

Addresses

Primary practice location

1853 R W Berends Dr SW
Wyoming, MI 49519-4955

Mailing address

1853 R W Berends Dr SW
Wyoming, MI 49519-4955
Phone (616) 534-9300

Other identifiers 1

IdentifierTypeStateIssuer
1669596284MedicaidMI

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)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704198105MIMDHome Health Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1760988752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1853 R W BERENDS DR SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495194955",
            "telephone_number": "616-534-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1853 R W BERENDS DR SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495194955",
            "telephone_number": "616-534-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRICKE",
        "first_name": "KATHRYN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-30",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MI",
            "license": "4704198105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669596284",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.