NPIMap

Individual provider Active NPI

Katie Jean Des Jardins

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1982075701
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
14228-33 Issued in WI
Practice address
1301 E Northland Ave Ste B
Appleton, WI 54911-8582
Phone
(920) 731-1999
Fax
(920) 731-3729
NPI assigned
Oct 20, 2015
Last updated
Feb 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 14228-33 WI Primary
Registered Nurse 163W00000X 247937-30 WI
Athletic Trainer 2255A2300X 1922-39 WI

Addresses

Primary practice location

1301 E Northland Ave Ste B
Appleton, WI 54911-8582

Mailing address

1301 E Northland Ave Ste B
Appleton, WI 54911-8582
Phone (920) 731-1999

Other practice location 1

1301 E Northland Ave Ste B
Appleton, WI 54911-8582
Phone (920) 731-1999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250108002023 WI Practitioner - Nurse Practitioner 6002344769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1301 E Northland Ave
Suite B
Appleton, WI 54911-8582
Phone (920) 702-5484

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
247937-30WIMDRegistered Nurse
1922-39WIMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Wisconsin Foot and Ankle Assoc., S.C. CurrentSince Jan 1, 2025 Accepting new patients
Northeast Wisconsin Foot and Ankle Assoc., S.C. CurrentSince Jan 1, 2025 Accepting new patients

Locations

1301 E Northland Ave
Ste B
Appleton, WI 54911
Phone (920) 702-5484

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1982075701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 E NORTHLAND AVE STE B",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118582",
            "telephone_number": "920-731-1999",
            "fax_number": "920-731-3729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E NORTHLAND AVE STE B",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118582",
            "telephone_number": "920-731-1999",
            "fax_number": "920-731-3729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 E Northland Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549118582",
            "country_code": "US",
            "telephone_number": "920-731-1999",
            "fax_number": "920-731-3729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DES JARDINS",
        "first_name": "KATIE",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-20",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "14228-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "247937-30",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "1922-39",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.