Provider Demographics
NPI:1689027344
Name:DYGART, KRISTY NICOLE-ORTHA (NP)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:NICOLE-ORTHA
Last Name:DYGART
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:BELOIT CLINIC
Mailing Address - Street 2:1905 E. HUEBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:BELOIT CLINIC
Practice Address - Street 2:1905 E. HUEBBE PARKWAY
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2230
Practice Address - Fax:608-363-7394
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-016098363L00000X
WI7056-33363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100058639Medicaid