Provider Demographics
NPI:1609379890
Name:MANN, KATELYNN (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4243
Practice Address - Country:US
Practice Address - Phone:972-943-8440
Practice Address - Fax:972-943-8348
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily