Healthcare Provider Details

I. General information

NPI: 1144112939
Provider Name (Legal Business Name): ALISHA LEIGH KINNEY AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 N PORT WASHINGTON RD STE 104
MEQUON WI
53097-2422
US

IV. Provider business mailing address

1920 BLACKHAWK DR
GRAFTON WI
53024-2811
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-5044
  • Fax:
Mailing address:
  • Phone: 920-539-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17096
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: