Provider Demographics
NPI:1588175491
Name:ULRICH, KATIE BETTYJEAN (MMS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:BETTYJEAN
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 5TH STREET HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1739
Mailing Address - Country:US
Mailing Address - Phone:610-208-8800
Mailing Address - Fax:
Practice Address - Street 1:4301 5TH STREET HWY STE 100
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560-1739
Practice Address - Country:US
Practice Address - Phone:610-208-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant