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MRS. KATHRYN LYNN PETERSEN RN
NPI 1235616269
Nurse Practitioner in Green Bay, WI

Active since July 23, 2018
704 S WEBSTER AVE STE 501, GREEN BAY, WI 54301(920) 433-6050(920) 433-6049 Get Directions Write a Review

NPPES record last updated: August 14, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 14, 2018, Jul 23, 2018 (2 updates tracked since 2018).

About Mrs. Kathryn Lynn Petersen Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KATHRYN LYNN PETERSEN RN (NPI 1235616269) is an individual nurse practitioner in Green Bay, Wisconsin, licensed in Wisconsin (8598-33) and active in the NPI registry since July 2018. She maintains 2 additional practice locations.

NPPES Registry Identity

NPI1235616269
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameMRS. KATHRYN LYNN PETERSENCredential: RN
Location Address704 S WEBSTER AVE STE 501Green Bay, WI 54301
Mailing AddressPo Box 22487Green Bay, WI 54305-2487 · (920) 445-7222 · Fax (920) 445-7289
Phone(920) 433-6050
Fax(920) 433-6049
Sole ProprietorNo
Enumeration DateJuly 23, 2018
Last NPPES UpdateAugust 14, 20182 updates tracked since enumeration
✔ NPI 1235616269 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in WI · 8598-33
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedRegistered NurseTaxonomy 163W00000X · License 168554-30 (WI)
704 S WEBSTER AVE STE 501, Green Bay, WI 54301
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Other Names 1

Former Name (1)Kathryn L Roethle Apnp

Secondary Practice Locations 2

Location 1744 S Webster AveGreen Bay, WI 54301-3505 · Phone (920) 433-3500
Location 2311 N 3rd AveSturgeon Bay, WI 54235-2401 · Phone (920) 433-6050 · Fax (920) 433-6049

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BROOKE WINCH RD, CD
Dietitian, Registered
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
AMANDA MARIE KILGORE APNP
Nurse Practitioner (Family)
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
JAIMEE M LARSON PA-C
Physician Assistant
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
DR. DAVID J. BROOKS M.D.
Internal Medicine (Infectious Disease)
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
REGINA CHARMAIN YOUNG CD
Dietitian, Registered
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
CASEY M ROSS APNP
Nurse Practitioner (Family)
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050
HANNAH BLUM RD
Dietitian, Registered
704 S WEBSTER AVE STE 501
GREEN BAY, WI 54301
Brown County (920) 433-6050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathryn Petersen's NPI number?

The NPI number for Kathryn Petersen is 1235616269. It was assigned to this individual provider in the NPPES registry on July 23, 2018. The provider is also known as Kathryn L Roethle Apnp.

Where is Kathryn Petersen located?

Kathryn Petersen practices at 704 S Webster Ave Ste 501, Green Bay, WI 54301. The listed phone number is (920) 433-6050.

What is Kathryn Petersen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Kathryn Petersen was last updated on August 14, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.