Provider Demographics
NPI:1881842938
Name:MARTIN, KELLY C (APNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:C
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:1458 HORIZON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5790
Mailing Address - Country:US
Mailing Address - Phone:262-632-1100
Mailing Address - Fax:262-632-1101
Practice Address - Street 1:1458 HORIZON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5790
Practice Address - Country:US
Practice Address - Phone:262-632-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI348033363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care