Individual
KYM A PHARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC, FNP-B
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
PO BOX 301, PORTAGE, WI 53901-0301
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
193271
WI
363LF0000X
Family Nurse Practitioner
7832-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7832-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467976357
—
WI
Enumeration date
08/01/2017
Last updated
02/07/2023
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