Healthcare Provider Details

I. General information

NPI: 1902239403
Provider Name (Legal Business Name): KATELYN A BEHRING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN HOYLMAN PA-C

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N LAKE DR SUITE 100
MILWAUKEE WI
53211-4528
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD CSMCP CLINIC CREDENTIALING
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-7250
  • Fax: 414-298-7251
Mailing address:
  • Phone: 414-298-7250
  • Fax: 414-298-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-009873
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3202-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: