Provider Demographics
NPI:1114385069
Name:PRZYBYSZEWSKI, KATELYN (MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
Last Name:PRZYBYSZEWSKI
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8255
Mailing Address - Country:US
Mailing Address - Phone:575-532-8900
Mailing Address - Fax:575-532-8910
Practice Address - Street 1:4371 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8255
Practice Address - Country:US
Practice Address - Phone:575-532-8900
Practice Address - Fax:575-532-8910
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005219363AM0700X
NMPA2016-0102363AM0700X
NY027427363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical