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General NPI Number Information
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NPI Number | 1497632103
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Entity Type | Individual
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Provider Name | KIMBERLY KATE MIZELLE APNP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | N2950 STATE ROAD 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2655
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Country | US
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Telephone | 262-245-0535
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Fax | 262-245-4627
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Provider Business Mailing Address
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Address Line | 225 GRACE ST
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City | WALWORTH
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State | WI
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Zip | 53184-9636
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Country | US
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Telephone | 262-745-9353
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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 | 179925-30
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License Number State | WI
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