Provider Demographics
NPI:1750851853
Name:CARROLL, KATELYN NICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICHELLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:NICHELLE
Other - Last Name:SWAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1101
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-598-2700
Mailing Address - Fax:304-598-2725
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1143
Practice Address - Country:US
Practice Address - Phone:304-598-2700
Practice Address - Fax:304-598-2725
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner