KELLY FLACK (NPI# 1720601297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720601297 |
| Entity Type | Individual |
| Full Name | KELLY FLACK |
| Credential | APNP |
| Practice Address |
2428 Pinehurst Cir Green Bay WI 54302-4215 |
| Practice Telephone | 9205620686 |
| Mailing Telephone | 9205620686 |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2020-10-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 177650-30 | WI | Nursing Service Providers |
| N | 363L00000X | Nurse Practitioner | 10176-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
10176-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | WISCONSIN APNP LICENSE | 10176-33 | 01 |
| WI | WISCONSIN RN LICENSE | 177650-30 | 01 |
| Street Address |
2428 PINEHURST CIR |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54302-4215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659721371 | Carissa Marie Sawicki | Counselor | 1234 Main Street, Suite 21, 3rd Floor, Green Bay, WI 54302 | 2016-06-14 |
| 1891181459 | Shannon Rae Mullins | Registered Nurse | 2254 Imperial Ln, Green Bay, WI 54302 | 2015-04-10 |
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1407003577 | Abby Baumgart | Counselor | 1234-21 Main St, Green Bay, WI 54302 | 2008-08-20 |
| 1447441779 | Muller Eyecare Associates Ltd | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-08-01 |
| 1851385231 | Bornemann Nursing Home Inc | Skilled Nursing Facility | 226 Bornemann St, Green Bay, WI 54302 | 2005-08-31 |
| 1194188706 | Familia Dental Green Bay LLC | Dentist | 1931 Main St., Green Bay, WI 54302 | 2016-03-31 |
| 1255710125 | Kim Lawrence | Social Worker | 1234 Main St., St 21, 3rd Floor, Green Bay, WI 54302 | 2015-05-26 |
| 1255464533 | John Muller | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-03-14 |
| 1851622005 | Michael Andrew Larkey | Social Worker | 815 Reber St, Green Bay, WI 54302-1116 | 2010-01-27 |
| Find all providers in zip 54302 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353763 | Tiffany Dahlke | Nurse Practitioner | 2427 Bluestone Pl, Green Bay, WI 54311-6433 | 2020-03-30 |
| 1285121707 | Deanna Danelle Olk | Nurse Practitioner | 917 Lincoln St, Green Bay, WI 54303-3625 | 2018-04-19 |
| 1306221619 | Karen M Kroll | Nurse Practitioner | 1630 Commanche Ave Ste 102, Green Bay, WI 54313-5753 | 2015-07-28 |
| 1770968760 | Esmaeil Ben Kamali | Nurse Practitioner | 725 S Webster Ave Ste 201, Green Bay, WI 54301-3500 | 2015-07-20 |
| 1427338730 | Natasha M Koehler | Nurse Practitioner | 2749 E Carrera Ct, Green Bay, WI 54311-7278 | 2011-08-18 |
| 1780982397 | Seth Patrick Moore | Nurse Practitioner | 879 Mather St, Green Bay, WI 54303-3651 | 2011-03-06 |
| 1316263569 | Chris Edwin Anibal | Nurse Practitioner | 744 South Webster Avenue, Green Bay, WI 54305-3500 | 2010-04-13 |
| 1184956864 | Douglas A Bartelt | Nurse Practitioner | 464 Cardinal Lane, Green Bay, WI 54313-9569 | 2010-02-05 |
| 1750504916 | Heather Mary Weber | Nurse Practitioner | 622 Bodart St, Green Bay, WI 54301 | 2007-04-10 |
| 1346314937 | Denise Mary Brilliant | Nurse Practitioner | 2340 E Mason St, Green Bay, WI 54302-3746 | 2006-11-17 |
| Find all providers in GREEN BAY | ||||
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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.