Provider Demographics
NPI:1003463365
Name:PEPER, KATIE (NP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PEPER
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:E5139 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53943-9719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:S2845 WHITE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9064
Practice Address - Country:US
Practice Address - Phone:608-355-1240
Practice Address - Fax:608-355-5166
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9383-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095623Medicaid
NAOtherI DO NOT HAVE A NUMBER