Provider Demographics
NPI:1598393050
Name:ARNOLD, KATELIN NICOLE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATELIN
Middle Name:NICOLE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8332
Mailing Address - Country:US
Mailing Address - Phone:208-415-5100
Mailing Address - Fax:
Practice Address - Street 1:8500 N ATLAS RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8332
Practice Address - Country:US
Practice Address - Phone:208-415-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66135363LF0000X
IDTEMP66135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP145730OtherBOARD OF NURSING
ID1598393050Medicaid
ID66135OtherBOARD OF NURSING- CERTIFIED NP/APRN