Healthcare Provider Details

I. General information

NPI: 1265748503
Provider Name (Legal Business Name): KAYLA ANN STANKOWSKI JOHNSON LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ANN STANKOWSKI LAT, ATC

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 W INTEGRITY WAY
APPLETON WI
54913-8602
US

IV. Provider business mailing address

5526 W MICHAELS DR APT 1
APPLETON WI
54913-8644
US

V. Phone/Fax

Practice location:
  • Phone: 844-274-6849
  • Fax:
Mailing address:
  • Phone: 715-240-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1348-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: