Provider Demographics
NPI:1417561283
Name:MASTERS, KATIE J
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:MASTERS
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 1:84 MOUNT NEBO RD
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHT
Mailing Address - State:WV
Mailing Address - Zip Code:26519-7198
Mailing Address - Country:US
Mailing Address - Phone:304-435-8705
Mailing Address - Fax:
Practice Address - Street 1:84 MOUNT NEBO RD
Practice Address - Street 2:
Practice Address - City:ALBRIGHT
Practice Address - State:WV
Practice Address - Zip Code:26519-7198
Practice Address - Country:US
Practice Address - Phone:304-435-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant