Provider Demographics
NPI:1710686803
Name:ALVEY, KATELYNN MARIE
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MARIE
Last Name:ALVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 EXPEDITION TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-5068
Mailing Address - Country:US
Mailing Address - Phone:502-777-7064
Mailing Address - Fax:
Practice Address - Street 1:3514 N POWER RD STE 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2909
Practice Address - Country:US
Practice Address - Phone:480-827-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ284819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner