Provider Demographics
NPI:1508321431
Name:STECHSCHULTE, KATELYN ELLEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ELLEN
Last Name:STECHSCHULTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:ELLEN
Other - Last Name:UTENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 YANKEE PARK PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1868
Mailing Address - Country:US
Mailing Address - Phone:937-439-4949
Mailing Address - Fax:
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1868
Practice Address - Country:US
Practice Address - Phone:937-439-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.415162163W00000X
OHAPRN.CNP.024011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0341058Medicaid