Provider Demographics
NPI:1497549570
Name:POOLE, KATIE LYN (DNP, MSN, BSN-RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:POOLE
Suffix:
Gender:F
Credentials:DNP, MSN, BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STONEY HILL LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9182
Mailing Address - Country:US
Mailing Address - Phone:608-598-0880
Mailing Address - Fax:
Practice Address - Street 1:700 STONEY HILL LN
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9182
Practice Address - Country:US
Practice Address - Phone:608-598-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI258289-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse