Healthcare Provider Details

I. General information

NPI: 1710946926
Provider Name (Legal Business Name): HOPE M KELLING FNP-C, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/18/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 S 27TH ST
GREENFIELD WI
53221-2652
US

IV. Provider business mailing address

4931 S 27TH ST
GREENFIELD WI
53221-2652
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-9533
  • Fax:
Mailing address:
  • Phone: 414-281-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9776-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143510
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: