Healthcare Provider Details

I. General information

NPI: 1558284877
Provider Name (Legal Business Name): TIPHANY LOUISE KOKOTT RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 MCHUGH RD
HOLMEN WI
54636-9296
US

IV. Provider business mailing address

1019 MCHUGH RD
HOLMEN WI
54636-9296
US

V. Phone/Fax

Practice location:
  • Phone: 608-526-6610
  • Fax:
Mailing address:
  • Phone: 608-526-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number118107-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: