KRISTEN JEANNE BROCKDORF (NPI# 1558882555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558882555 |
| Entity Type | Individual |
| Full Name | KRISTEN JEANNE BROCKDORF |
| Other Name | KRISTEN JEANNE BAUGNET |
| Credential | PA-C |
| Practice Address |
1818 N Meade St Appleton WI 54911-3454 |
| Mailing Address |
1401 14th Ave Green Bay WI 54304-3420 |
| Practice Telephone | 9207314101 |
| Mailing Telephone | 7158501126 |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2019-03-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
249004 | WI | Technologists, Technicians & Other Technical Service Providers |
| Y | 363A00000X | Physician Assistant | 404123 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
404123 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 130 2nd St, Neenah, WI 549562883 | 9207293100 | |
| 2500 E Capitol Dr, Appleton, WI 549118735 | 9203643600 | 9203643900 |
| Street Address |
1818 N MEADE ST |
| City | APPLETON |
| State | WI |
| Zip Code | 54911-3454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588666853 | Appleton Emergency Services S C | Emergency Medicine | 1818 N Meade St, Appleton, WI 54911-3454 | 2005-06-01 |
| 1720691553 | Katie Jo Bares | Physical Therapist | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-08-31 |
| 1306454053 | Samantha L Thiede | Nurse Practitioner | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-07-20 |
| 1346867272 | Lauren Renee Schauer | Registered Nurse | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-06-26 |
| 1790309755 | Lane Baumbach | Dietitian, Registered | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-06-04 |
| 1326661026 | Thedacare Regional Medical Center - Appleton, Inc. | Medicare Defined Swing Bed Unit | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-05-28 |
| 1568095016 | Samantha Putzer | Physician Assistant | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-02-12 |
| 1083245120 | Krystina L Putnam | Registered Nurse | 1818 N Meade St, Appleton, WI 54911-3454 | 2020-01-28 |
| 1366097040 | Kelsey G Alt | Physician Assistant | 1818 N Meade St, Appleton, WI 54911-3454 | 2019-08-08 |
| 1528611217 | Abigail M Witthuhn | Physician Assistant | 1818 N Meade St, Appleton, WI 54911-3454 | 2019-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| 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 |
|---|---|---|---|---|
| 1043811409 | Kristen T Razner | Physician Assistant | 2500 E Capitol Dr # 3700, Appleton, WI 54911-8735 | 2020-11-03 |
| 1659986677 | Jordana Butler | Physician Assistant | 2105 E Enterprise Ave # 101, Appleton, WI 54913-7862 | 2020-09-15 |
| 1073127049 | Dana Van De Hey | Physician Assistant | 616 White Birch Ct, Appleton, WI 54915-4516 | 2020-09-07 |
| 1417571035 | Paige Nicole Krieck | Physician Assistant | W6065 Moonflower Dr, Appleton, WI 54915-7440 | 2020-05-29 |
| 1346807146 | Riann Sue Collar | Physician Assistant | 247 S Nicolet Rd, Appleton, WI 54914-3938 | 2019-05-28 |
| 1518486919 | Angela Marie Heinkel | Physician Assistant | 2500 E Capitol Dr # 1200, Appleton, WI 54911-8735 | 2017-09-17 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1356691604 | Kelly M Cherne | Physician Assistant | 820 E Grant St Ste 230, Appleton, WI 54911-3441 | 2012-09-13 |
| 1912230954 | Justin Guzman | Physician Assistant | 2500 E Capitol Dr Ste 2500, Appleton, WI 54911-8735 | 2009-09-09 |
| 1316979248 | Megan Hotchkiss | Physician Assistant | 2500 E Capitol Drive, Suite 3700, Appleton, WI 54155 | 2006-07-07 |
| Find all providers in APPLETON | ||||
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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.