Provider Demographics
NPI:1972193241
Name:BECHARD, KELLY MARIE (APNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:BECHARD
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:PAULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 S HERITAGE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1408
Mailing Address - Country:US
Mailing Address - Phone:920-225-7875
Mailing Address - Fax:920-993-5003
Practice Address - Street 1:2600 S HERITAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1408
Practice Address - Country:US
Practice Address - Phone:920-225-7875
Practice Address - Fax:920-993-5003
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10778363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health