Provider Demographics
NPI:1093928418
Name:ZOELLNER, KELIN BARBARA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELIN
Middle Name:BARBARA
Last Name:ZOELLNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELIN
Other - Middle Name:B
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:223 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959
Mailing Address - Country:US
Mailing Address - Phone:608-768-3333
Mailing Address - Fax:608-768-3335
Practice Address - Street 1:223 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959
Practice Address - Country:US
Practice Address - Phone:608-768-3333
Practice Address - Fax:608-768-3335
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2689-23363AM0700X
WI2689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61140OtherDEAN HEALTH INSURANCE
WI61140OtherDEAN HEALTH INSURANCE
WIP01158637Medicare PIN
WIK400120419Medicare PIN