Provider Demographics
NPI:1801408539
Name:BRIGHT, KATELYN TAYLOR
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:TAYLOR
Last Name:BRIGHT
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 1:1701 ALDERSGATE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6675
Mailing Address - Country:US
Mailing Address - Phone:501-574-3053
Mailing Address - Fax:
Practice Address - Street 1:1701 ALDERSGATE RD STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6675
Practice Address - Country:US
Practice Address - Phone:501-574-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR932688519106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician