Provider Demographics
NPI:1699426320
Name:RYCHLOWSKI, KAITLYN ROSE (APNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:RYCHLOWSKI
Suffix:
Gender:F
Credentials:APNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WARREN ST STE 132
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3041
Mailing Address - Country:US
Mailing Address - Phone:920-356-6558
Mailing Address - Fax:
Practice Address - Street 1:130 WARREN ST STE 132
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3041
Practice Address - Country:US
Practice Address - Phone:920-356-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11809-33363LP0808X
WI239027-30163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health