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Kelsey Kannenberg

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

2901 W Kinnickinnic River Pkwy, Ste 511, Milwaukee, WI 53215-3677

PECOS Enrollment

Based on the most recent information from CMS, provider Kelsey Kannenberg is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:26 AM.

Profile Details

Provider ID
1881076669
Provider Type
Individual
Full Name
Kannenberg, Kelsey
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/29/2015
Last Updated
8/12/2024

Contact Information

Practice Location

2901 W Kinnickinnic River Pkwy, Ste 511, Milwaukee, WI 53215-3677

(414) 649-3780

Unlisted Fax

Mailing Location

PO Box 735044, Chicago, IL 60673-5044

(800) 326-2250

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 3594-23 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 100046786	Description Medicaid	Issuer Unlisted Wisconsin

Kelsey Kannenberg

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Scaletta, Giuseppa

Rogers, Krista N

Zimmet, Kristin L.

Daniels, Chelsea L

Mason, Emily

Dickmann, Alexis C

Campbell, Spencer A

Williams, Heather Joy

Notebaart, Katie C

Pittman, Jennifer Leigh