Healthcare Provider Details

I. General information

NPI: 1043460728
Provider Name (Legal Business Name): KATHLYN AUDREY KLEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S STOUGHTON RD
MADISON WI
53716-2257
US

IV. Provider business mailing address

1821 S STOUGHTON RD
MADISON WI
53716-2257
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-6000
  • Fax: 608-260-6484
Mailing address:
  • Phone: 608-260-6000
  • Fax: 608-260-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2314-023
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2314
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: