Provider Demographics
NPI:1235528373
Name:MCCLELLAND, KATYBETH (CRNP)
Entity Type:Individual
Prefix:
First Name:KATYBETH
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 FRIENDSHIP AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1722
Mailing Address - Country:US
Mailing Address - Phone:412-578-5858
Mailing Address - Fax:412-578-1529
Practice Address - Street 1:4800 FRIENDSHIP AVE FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1722
Practice Address - Country:US
Practice Address - Phone:412-578-5858
Practice Address - Fax:412-578-1529
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014343363LN0005X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103114204Medicaid