Backman, Kellie A

Backman, Kellie A is an individual health care provider with primary practice located at 3111 Gundersen Dr , Onalaska WI 54650-8447. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Backman, Kellie A can be contacted via phone (608) 775-8630.

Contact Information

Primary practice address
3111 Gundersen Dr Onalaska WI 54650-8447
Phone: (608) 775-8630
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 7082 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 1171 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 1171 Wisconsin

Profile Details

NPI number 1639171895
LBN Legal business name Backman, Kellie A
Credentials APNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Feb 6th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639171895 NPPES
Wisconsin MEDICAID 43870600

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