Active NPI
Kathleen M Peterson, NP
- Nurse Practitioner
- Appleton, WI
National Provider Identifier
1982956504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5090
- Practice address
- 4517 N Windingbrook Dr
Appleton, WI 54913-7764 - Phone
- (920) 858-9094
- NPI assigned
- Oct 5, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 143537 | WI | |
| Nurse Practitioner | 363L00000X | 5090 | WI | Primary |
Addresses
Primary practice location
4517 N Windingbrook Dr
Appleton, WI 54913-7764
Mailing address
4517 N Windingbrook Dr
Appleton, WI 54913-7764
Phone (920) 858-9094
Other practice location 1
411 Lincoln St
Neenah, WI 54956-2753
Phone (920) 727-4425
Other practice location 2
411 Lincoln St
Neenah, WI 54956-2753
Phone (920) 727-4425
Other practice location 3
4321 W College Ave Ste 200
Appleton, WI 54914-3968
Phone (866) 949-0108
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143537 | WI | MD | Nurse Practitioner |
Interoperability endpoints
- ms_kpete119@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650240000000",
"number": "1982956504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4517 N WINDINGBROOK DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549137764",
"telephone_number": "920-858-9094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4517 N WINDINGBROOK DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549137764",
"telephone_number": "920-858-9094"
}
],
"practiceLocations": [
{
"address_1": "411 Lincoln St",
"address_purpose": "LOCATION",
"city": "Neenah",
"state": "WI",
"postal_code": "549562753",
"country_code": "US",
"telephone_number": "920-727-4425",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "411 Lincoln St",
"address_purpose": "LOCATION",
"city": "Neenah",
"state": "WI",
"postal_code": "549562753",
"country_code": "US",
"telephone_number": "920-727-4425",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4321 W College Ave Ste 200",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549143968",
"country_code": "US",
"telephone_number": "866-949-0108",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-05",
"last_updated": "2022-04-18",
"certification_date": "2022-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "143537",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "5090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.