Provider Demographics
NPI:1962470757
Name:CASTILLE- ALIFFI, KATHY JEANETTE (APNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JEANETTE
Last Name:CASTILLE- ALIFFI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FRANCIS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277
Mailing Address - Country:US
Mailing Address - Phone:770-253-0611
Mailing Address - Fax:770-716-0087
Practice Address - Street 1:700 S PARK ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:608-260-2956
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA089463363LF0000X
WI16192-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962470757Medicaid
GA000800434LMedicaid
GAS59254Medicare UPIN