Individual
KILEY DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2365 DEMING WAY, MIDDLETON, WI 53562-5512
(608) 824-6160
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
4756
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063071157
—
WI
Enumeration date
06/12/2019
Last updated
02/08/2022
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