Provider Demographics
NPI:1174630057
Name:WOYACH, KIMBERLY A (DNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:WOYACH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KASTENSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:6611 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2632
Practice Address - Country:US
Practice Address - Phone:262-504-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107893-030363L00000X
WI2436-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41182600Medicaid