MARY R KELM NP NPI 1003802331

Nurse Practitioner in Fond Du Lac, WI

Individual Female Nurse Practitioner PECOS Enrolled

About MARY KELM

Mary Kelm is a provider established in Fond Du Lac, Wisconsin and her medical specialization is nurse practitioner. The NPI number of Mary Kelm is 1003802331 and was assigned on September 2005. The practitioner's primary taxonomy code is 363L00000X with license number 16033 (WI). The provider is registered as an individual and her NPI record was last updated 3 years ago. Mary Kelm is enrolled in PECOS.

NPI

1003802331

Provider Name MARY R KELM NP
Provider Location Address420 E DIVISION ST FOND DU LAC, WI 54935
Provider Mailing Address420 E DIVISION ST FOND DU LAC, WI 54935
GenderFemale
NPI Entity TypeIndividual
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date09-22-2005
Last Update Date03-28-2016

Primary Taxonomy

Taxonomy Code363L00000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.16033
License StateWI
Taxonomy Description(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Business Address

MARY R KELM NP
420 E DIVISION ST
FOND DU LAC, WI
ZIP 54935
Phone: (920) 926-8230

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Mailing Address

MARY R KELM NP
420 E DIVISION ST
FOND DU LAC, WI
ZIP 54935
Phone: (920) 926-8340
Fax: (920) 926-8370

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
P02949MEDICARE UPIN (02)

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1043293376 KRISTINE S TAIVALMAA MD
Individual
Pediatrics420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8424
1073595120 LUTTI PENTON MD
Individual
Surgery (Plastic and Reconstructive Surgery)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8614
1154595387AGNESIAN HEALTHCARE INC
Organization
Eyewear Supplier420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8316
1164693891DR. JOSHUA A MULTACK D.O.
Individual
Anesthesiology (Critical Care Medicine)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 929-2300
1184605891 JULIE A JOHNSON NP
Individual
Nurse Practitioner (Adult Health)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8420
1184874976DR. KRISTEN M WITKOWSKI MD
Individual
Obstetrics & Gynecology420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8340
1245213560 DAVID F SWEET MD
Individual
Ophthalmology420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8472
1285615328 DARRELL E HAY MD
Individual
Family Medicine420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8200
1407837537 YASIR HATAHET MD
Individual
420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8485
1417976200 MICHAEL J FREELAND MD
Individual
Internal Medicine (Critical Care Medicine)420 E DIVISION ST
FOND DU LAC, WI 54935
(217) 383-3266
1467571802DR. PATRICK J BISSELL MD
Individual
Anesthesiology420 E DIVISION ST
FON DU LAC, WI 54935
(920) 929-2300
1720061864 KIRK A VEIT MD
Individual
Pediatrics420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8424
1861423758 RICHARD A SANTA-CRUZ MD
Individual
Internal Medicine (Interventional Cardiology)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8230
1902094931 ANNMARIE E SWANSON APNP
Individual
Nurse Practitioner (Adult Health)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8340
1932459492 CYNTHIA A LIETHEN APNP
Individual
Nurse Practitioner420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-5666
1942282298 STEPHEN A MASSICK MD
Individual
Obstetrics & Gynecology420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8450
1952383044 TROY A KASUBOSKI MS, CCC-A
Individual
Audiologist420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8460
1952680498 LAURA JEAN BRAAKSMA DPT
Individual
Physical Therapist420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-5370
1962492397 DAVID R BOWMAN M.D.
Individual
Internal Medicine (Cardiovascular Disease)420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8420
1992787931 WARREN M POST MD
Individual
Pediatrics420 E DIVISION ST
FOND DU LAC, WI 54935
(920) 926-8424

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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