Provider Demographics
NPI:1164272027
Name:CARLSON, KATELYN ROSE
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ROSE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 S HIGH ST APT C3
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-7003
Mailing Address - Country:US
Mailing Address - Phone:740-274-6202
Mailing Address - Fax:
Practice Address - Street 1:157 S HIGH ST APT C3
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-7003
Practice Address - Country:US
Practice Address - Phone:740-274-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker