Provider Demographics
NPI:1023652310
Name:KILLOY, STEPHANIE JAN (APNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JAN
Last Name:KILLOY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JAN
Other - Last Name:REICHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-5442
Practice Address - Fax:608-265-1753
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9717-33363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics