KEVEN R MOTTINGER


Address: 3400 Market Ln, Kenosha, WI 53144-3430
Phone: 2625514600

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 1868 WI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
CAQH 12006222 01

Office Location

Street Address 3400 MARKET LN
City KENOSHA
State WI
Zip Code 53144-3430

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City KENOSHA
Zip Code 53144

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Dataset Information

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.

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