KELLY MARIE GALLOIS LARSON NP
NPI 1467169276
Nurse Practitioner - Psychiatric/Mental Health in Burlington, WI

Active since November 01, 2022PECOS EnrolledAccepts Medicare Assignment
116 N DODGE ST, BURLINGTON, WI 53105(414) 773-4312 Get Directions Write a Review

NPPES record last updated: December 15, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 15, 2025, Jan 18, 2023, Nov 30, 2022 and 1 more (4 updates tracked since 2022).

About Kelly Marie Gallois Larson Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY MARIE GALLOIS LARSON NP (NPI 1467169276) is an individual psychiatric/mental health provider in Burlington, Wisconsin, licensed in Wisconsin (13310) and active in the NPI registry since November 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1467169276
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameKELLY MARIE GALLOIS LARSONCredential: NP
Location Address116 N DODGE STBurlington, WI 53105-1963
Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateNovember 1, 2022
Last NPPES UpdateDecember 15, 20254 updates tracked since enumeration
NPPES CertifiedDecember 15, 2025
NPI 1467169276 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License Licensed in WI · 13310
Also ListedNurse PractitionerTaxonomy 363L00000X · License 13310 (WI)
116 N DODGE ST, Burlington, WI 53105

Other Identifiers 2

Medicaid100222156WI
Medicaid100222026WI

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kelly Marie Gallois Larson Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709255847
PECOS Enrollment IDI20221212000971
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
51 services16 patients
Psychiatric diagnostic evaluation with medical services 90792
A psychiatric diagnostic evaluation with medical services is a comprehensive assessment. It includes a detailed examination of your mental health and physical wellbeing, as well as your personal and family history. This evaluation aids in creating an effective treatment plan.
12 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53105 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Marriage & Family Therapist
116 N DODGE ST
BURLINGTON, WI 53105
Psychiatry & Neurology (Psychiatry)
116 N DODGE ST
BURLINGTON, WI 53105

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Larson's NPI number?

The NPI number for Kelly Larson is 1467169276. It was assigned to this individual provider in the NPPES registry on November 1, 2022.

Where is Kelly Larson located?

Kelly Larson practices at 116 N Dodge St, Burlington, WI 53105. The listed phone number is (414) 773-4312.

What is Kelly Larson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Kelly Larson enrolled in Medicare?

Yes. Kelly Larson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kelly Larson accept?

Health plans from Aspirus Health Plan, CareSource (Common Ground Healthcare), HealthPartners, Medica and Quartz and 1 other insurer list Kelly Larson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Larson was last updated on December 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.