Healthcare Provider Details

I. General information

NPI: 1003600149
Provider Name (Legal Business Name): KAILIE BECK ANPN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 S MADISON ST
APPLETON WI
54915-1800
US

IV. Provider business mailing address

1740 13TH AVE
GREEN BAY WI
54304-3717
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2000
  • Fax:
Mailing address:
  • Phone: 920-321-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16455-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: