Kathryn Diane Taillie, PA-C
Individual provider Active NPI Physician Assistant · Wauwatcsa, WI
NPI 1982146213 · NPPES record last updated Apr 6, 2021
Key facts
- NPI
- 1982146213
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085.006036 (IL)
- Practice address
- 2885 N Mayfair Rd
Wauwatcsa, WI 53222-4404 - Phone
- (414) 771-6780
- Fax
- (414) 238-2424
- NPI assigned
- Nov 17, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181227002227 | WI | Practitioner - Physician Assistant | 0345585014 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.006036 | IL | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.006036 | IL | Yes |
Addresses
Primary practice location
2885 N Mayfair Rd
Wauwatcsa, WI 53222-4404
Mailing address
10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (414) 771-6780
Other names
- Kathryn D Dempsey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.