Provider Demographics
NPI:1952743072
Name:SPORS, KATHRYN L (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:SPORS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:GACKSTATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 W ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-2048
Mailing Address - Country:US
Mailing Address - Phone:920-674-6255
Mailing Address - Fax:920-674-5288
Practice Address - Street 1:1225 REMMEL DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53094-8511
Practice Address - Country:US
Practice Address - Phone:920-674-6255
Practice Address - Fax:920-674-5288
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161498-30163W00000X
WI5367-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse