Healthcare Provider Details

I. General information

NPI: 1942188206
Provider Name (Legal Business Name): JENNIFER KILMER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N BROADWAY
GREEN BAY WI
54303-3426
US

IV. Provider business mailing address

1571 ALAMOSA TRL
GREEN BAY WI
54313-3967
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-7206
  • Fax:
Mailing address:
  • Phone: 920-594-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1733333
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1733333
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: