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General NPI Number Information
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NPI Number | 1912475393
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Entity Type | Individual
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Provider Name | KATLYNN ANN KELLEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 20 S PARK ST RM M417
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City | MADISON
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State | WI
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Zip | 53715-1348
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Country | US
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Telephone | 414-573-8992
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Fax |
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Provider Business Mailing Address
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Address Line | 335 LONGFIELD ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1236
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Country | US
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Telephone | 414-573-8992
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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 | 8794-33
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License Number State | WI
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