Healthcare Provider Details

I. General information

NPI: 1902730310
Provider Name (Legal Business Name): KAYLA MARKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 N LAKE SHORE DR
MEQUON WI
53097-2418
US

IV. Provider business mailing address

W298S2975 RIDGEWOOD DR
WAUKESHA WI
53188-9269
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-5700
  • Fax:
Mailing address:
  • Phone: 262-442-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1850133
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: