KELLY THEODORE PMHNP FNP NPI 1821472226

NPI Information

NPI: 1821472226
Provider Name: KELLY THEODORE, PMHNP, FNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
930 E KNAPP ST
STE 34
MILWAUKEE, WI
ZIP 53202
Phone: (414) 671-9355
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Kelly Theodore, PMHNP, FNP is a psychiatric/mental health nurse practitioner in Milwaukee, WI with 6 years of experience. Kelly Theodore, PMHNP, FNP NPI is 1821472226. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

930 E KNAPP ST
STE 34
MILWAUKEE, WI
ZIP 53202
Phone: (414) 671-9355
Fax: (888) 376-4067

The NPI 1821472226 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/15/2015 and was last updated on 2/13/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	6467-33	WISCONSIN	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	6467	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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