Provider Demographics
NPI:1003598814
Name:COYLE, KATELYN (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 PINE GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4059
Mailing Address - Country:US
Mailing Address - Phone:563-513-8723
Mailing Address - Fax:
Practice Address - Street 1:3606 PINE GROVE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4059
Practice Address - Country:US
Practice Address - Phone:563-513-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14336-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner