KEVEN R MOTTINGER (NPI# 1154377091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154377091 |
Entity Type | Individual |
Full Name | KEVEN R MOTTINGER |
Credential | PAC |
Practice Address |
3400 Market Ln Kenosha WI 53144-3430 |
Mailing Address |
4536 22nd Ave Kenosha WI 53140-5917 |
Practice Telephone | 2625514600 |
Practice Fax Number | 2625514630 |
Mailing Telephone | 2626560044 |
Mailing Fax Number | 2626532218 |
Enumeration Date | 2006-05-25 |
Last Update Date | 2020-08-31 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363A00000X | Physician Assistant | 1868 | WI | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CAQH | 12006222 | 01 |
Street Address |
3400 MARKET LN |
City | KENOSHA |
State | WI |
Zip Code | 53144-3430 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083261226 | Amanda Quinonez | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2019-08-22 |
1629534813 | Heather Nicole Thomas | Registered Nurse | 3400 Market Ln, Kenosha, WI 53144-3430 | 2019-02-13 |
1922573625 | Tarren Prange | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2018-10-09 |
1891260543 | Stephanie M Brown | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2018-10-09 |
1790297331 | Juli Marie Degrave | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-11-03 |
1750800884 | Christos Reppas | Physician Assistant | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-09-09 |
1417497710 | Shelley Flasch | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-03-06 |
1194193813 | Sandra Homan | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2015-09-11 |
1326452921 | Rebekah Costello | Family Medicine | 3400 Market Ln, Kenosha, WI 53144-3430 | 2014-06-12 |
1710306725 | Christine T Adique | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2014-04-08 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902410202 | Dpt Holdings LLC | Occupational Therapist | 3825 39th Ave #110, Kenosha, WI 53144 | 2020-09-03 |
1225641392 | Eunice Boatin | Social Worker | Kenosha Human Development Services, 3536 52nd Street, Kenosha, WI 53144 | 2020-08-28 |
1881250256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3621 Market Lane, Kenosha, WI 53144 | 2019-05-11 |
1124540067 | Kaitlyn King | Speech-Language Pathologist | 5219 88th Ave., Kenosha, WI 53144 | 2017-07-12 |
1174992721 | Claire Ann Adams | Acupuncturist | 5416 52nd Street, Kenosha, WI 53144 | 2015-09-24 |
1285017087 | Jessica Lynn Gillengerten | Acupuncturist | 4235 Green Bay Rd., Suite #10, Kenosha, WI 53144 | 2015-06-30 |
1750704656 | Amanda Kay Kreuzer | Occupational Therapy Assistant | 3109 30th Ave, Kenosha, WI 53144 | 2014-01-28 |
1841626785 | B7 Pharmacy Inc | Pharmacy | 3825 39th Ave Ste 100, Kenosha, WI 53144 | 2013-09-24 |
1124326764 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3710 57th Ave, Kenosha, WI 53144 | 2011-03-07 |
1982931291 | Roman Bilak | General Practice | 4126 - 7th Street, Kemosha, WI 53144 | 2009-11-06 |
Find all providers in zip 53144 |
Taxonomy Code | 363A00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043843592 | Brian Owings | Physician Assistant | 3400 Market Ln # 300, Kenosha, WI 53144-3430 | 2020-02-12 |
1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
1215311881 | Sarah Ann Moony | Physician Assistant | 8500 75th St Ste 102, Kenosha, WI 53142-8213 | 2015-07-14 |
1194097311 | Emily Ann Lee | Physician Assistant | 10400 75th St Ste 215, Kenosha, WI 53142-7884 | 2012-02-03 |
1629364815 | Alyssa M Ricchio | Physician Assistant | 10400 75th St Ste 700, Kenosha, WI 53142-7884 | 2011-06-26 |
1649506874 | Briana Elizabeth Aiken | Physician Assistant | 2801 14th Pl, Kenosha, WI 53140-4300 | 2009-10-22 |
1144317736 | Sarah N Stachon | Physician Assistant | 8959 34th Ave, Kenosha, WI 53142-5412 | 2006-10-06 |
1457468654 | Yasmine S Sido | Physician Assistant | 7550 22nd Ave, Kenosha, WI 53143 | 2006-08-24 |
1164056727 | Michael James Church | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-02-23 |
1972133031 | Patricia Grzyb | Physician Assistant | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
Find all providers in KENOSHA |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.