Active NPI
Jennifer Kristin Prom, APNP
- Family Nurse Practitioner
- Cedarburg, WI
National Provider Identifier
1902153844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4891-33
- Practice address
- 9025 Oakridge LN
Cedarburg, WI 53012-9388 - Phone
- (262) 375-6858
- NPI assigned
- Aug 9, 2012
- Last updated
- Aug 9, 2012
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4891-33 | WI | Primary |
Addresses
Primary practice location
9025 Oakridge LN
Cedarburg, WI 53012-9388
Mailing address
9025 Oakridge LN
Cedarburg, WI 53012-9388
Phone (262) 375-6858
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4891-33 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344470400000",
"number": "1902153844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9025 OAKRIDGE LN",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129388",
"telephone_number": "262-375-6858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9025 OAKRIDGE LN",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129388",
"telephone_number": "262-375-6858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROM",
"first_name": "JENNIFER",
"middle_name": "KRISTIN",
"name_prefix": "Mrs.",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-09",
"last_updated": "2012-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "4891-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedarburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.