MEDICARE: MS. KELLY C. MARTIN APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	348033	WI

General Provider Information

NPI Number	:	1881842938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY C. MARTIN APNP

Provider Business Mailing Address
First Line	:	1458 HORIZON BLVD STE 150
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-5790
Country	:	US
Telephone Number	:	262-632-1100
Fax Number	:	262-632-1101

Provider Business Practice Location Address
First Line	:	1458 HORIZON BLVD STE 150
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-5790
Country	:	US
Telephone Number	:	262-632-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	07/24/2025

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