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General NPI Number Information
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NPI Number | 1164181665
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Entity Type | Individual
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Provider Name | KATIE MCCARTY NP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2021
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Last Update Date | 12/12/2021
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Provider Practice Location Address
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Address Line | W1234 ROME RD
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City | RUBICON
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State | WI
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Zip | 53078-9516
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Country | US
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Telephone | 715-781-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 2872 NORTHWYNDE PSGE
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-9117
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Country | US
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Telephone | 715-781-0401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11049
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License Number State | WI
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