Active NPI
Aemelia Anne Tallen-Whited, CPNP
- Pediatric Nurse Practitioner
- Kenosha, WI
National Provider Identifier
1831402734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4695-33
- Practice address
- 6308 8TH Ave
Suite 1040
Kenosha, WI 53143-5031 - Phone
- (262) 653-5437
- Fax
- (262) 656-3415
- NPI assigned
- Jul 20, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4695-33 | WI | Primary |
Addresses
Primary practice location
6308 8TH Ave
Suite 1040
Kenosha, WI 53143-5031
Mailing address
6308 8TH Ave
Suite 1040
Kenosha, WI 53143-5031
Phone (262) 653-5437
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4695-33 | Other | WI | LICENSE |
| 1831402734 | 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
- Certified Pediatric Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenosha Pathology Consultants | Past | Accepting new patients | |
| Froedtert South, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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 Medicine Physician
- Kenosha, WI
- NPI 1558305284
-
- Anatomic Pathology & Clinical Pathology Physician
- Kenosha, WI
- NPI 1790812857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362355200000",
"number": "1831402734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6308 8TH AVE",
"address_2": "SUITE 1040",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "262-653-5437",
"fax_number": "262-656-3415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6308 8TH AVE",
"address_2": "SUITE 1040",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "262-653-5437",
"fax_number": "262-656-3415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALLEN-WHITED",
"first_name": "AEMELIA",
"middle_name": "ANNE",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-20",
"last_updated": "2013-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WI",
"license": "4695-33",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "4695-33",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831402734",
"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 Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.