Provider Demographics
NPI:1164181665
Name:MCCARTY, KATIE (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SIEWERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2872 NORTHWYNDE PSGE
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9117
Mailing Address - Country:US
Mailing Address - Phone:715-781-0401
Mailing Address - Fax:
Practice Address - Street 1:W1234 ROME RD
Practice Address - Street 2:
Practice Address - City:RUBICON
Practice Address - State:WI
Practice Address - Zip Code:53078-9516
Practice Address - Country:US
Practice Address - Phone:715-781-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily