Provider Demographics
NPI:1245109735
Name:KINGSBURY, KATELYNN
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SOUTH OAK STREET
Mailing Address - Street 2:PO BOX 276
Mailing Address - City:NORTH FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:53951
Mailing Address - Country:US
Mailing Address - Phone:608-377-3524
Mailing Address - Fax:
Practice Address - Street 1:414 STATE ROAD 136
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1193
Practice Address - Country:US
Practice Address - Phone:608-356-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI237567-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management