Provider Demographics
NPI:1417422551
Name:ELLIOTT, KATELYN BROOKE (RN, WHNP, CNM)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:BROOKE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RN, WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 SW 1ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2890
Mailing Address - Country:US
Mailing Address - Phone:949-636-9444
Mailing Address - Fax:
Practice Address - Street 1:12220 SW 1ST ST STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2890
Practice Address - Country:US
Practice Address - Phone:888-875-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202207585NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner