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General NPI Number Information
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NPI Number | 1205312923
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Entity Type | Individual
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Provider Name | KRISTIN LEIGH DOCTER APNP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 225 CHURCH ST
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City | STOUGHTON
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State | WI
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Zip | 53589-1801
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Country | US
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Telephone | 608-877-2777
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Fax | 608-877-2774
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Provider Business Mailing Address
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Address Line | 1808 W BELTLINE HWY
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City | MADISON
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State | WI
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Zip | 53713-2334
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Country | US
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Telephone | 608-250-1497
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Fax | 608-250-1384
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 198855
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041429640
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017967
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9317-33
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9317-33
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License Number State | WI
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