Provider Demographics
NPI:1508384868
Name:KNEPEL, KATHRYN RAE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RAE
Last Name:KNEPEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RAE
Other - Last Name:FREDERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:1640 E SUMNER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2684
Practice Address - Country:US
Practice Address - Phone:262-670-4000
Practice Address - Fax:262-640-4451
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA129763363LF0000X
WI102355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100296661Medicaid