Provider Demographics
NPI:1568128569
Name:ROY, KATHERINE ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:ROY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 S SEPULVEDA BLVD APT 2542
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1798
Mailing Address - Country:US
Mailing Address - Phone:860-460-5238
Mailing Address - Fax:
Practice Address - Street 1:14735 VENTURA BLVD # 9868
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3679
Practice Address - Country:US
Practice Address - Phone:818-788-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily