Provider Demographics
NPI:1033627336
Name:BEEMON, KATELYN D (APNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:D
Last Name:BEEMON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:M
Other - Last Name:DIBENEDETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:3051 CAHILL MAIN
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3051 CAHILL MAIN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7109
Practice Address - Country:US
Practice Address - Phone:608-661-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8642-33363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner