Active NPI
Kathryn Wirtz, PA
- Physician Assistant
- Sussex, WI
National Provider Identifier
1891762159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 339-023
- Practice address
- W227N6103 Sussex Rd
Sussex, WI 53089-3969 - Phone
- (414) 566-8100
- Fax
- (414) 566-8038
- NPI assigned
- Mar 7, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 339-023 | WI | Primary |
Addresses
Primary practice location
W227N6103 Sussex Rd
Sussex, WI 53089-3969
Mailing address
3300 N 124TH St
Wauwatosa, WI 53222-3106
Phone (414) 778-6200
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 |
|---|---|---|---|
| 339 | WI | MD | Clinical Social Worker |
| 339-023 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647907200000",
"number": "1891762159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 N 124TH ST",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532223106",
"telephone_number": "414-778-6200",
"fax_number": "414-778-6222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W227N6103 SUSSEX RD",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530893969",
"telephone_number": "414-566-8100",
"fax_number": "414-566-8038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRTZ",
"first_name": "KATHRYN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-07",
"last_updated": "2022-03-22",
"certification_date": "2022-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "339-023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sussex, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.