Provider Demographics
NPI:1194216168
Name:MEIER, KAITLIN (NP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MEIER
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 1:6308 8TH AVENUE
Mailing Address - Street 2:ATTN: MED. STAFF OFC.
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-0531
Mailing Address - Country:US
Mailing Address - Phone:262-653-5330
Mailing Address - Fax:262-653-5346
Practice Address - Street 1:6308 8TH AVE # 202
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143
Practice Address - Country:US
Practice Address - Phone:262-653-5330
Practice Address - Fax:262-653-5346
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI188983-30163W00000X
WI8544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1194216168Medicaid
WI188983-30OtherRN LICENSE
WI8544-33OtherAPNP LICENSE
WIK400497287OtherMEDICARE (FROEDTERT SOUTH)