Healthcare Provider Details

I. General information

NPI: 1972193241
Provider Name (Legal Business Name): KELLY MARIE BECHARD APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE PAULLIN

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9
WINNEBAGO WI
54985-0009
US

IV. Provider business mailing address

PO BOX 9 1300 SOUTH DRIVE
WINNEBAGO WI
54985-0009
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-4910
  • Fax:
Mailing address:
  • Phone: 920-235-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10778
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: