Provider Demographics
NPI:1013533520
Name:RICHTER, KATELYN JEANNE (APRN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:JEANNE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JEANNE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2414 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6500
Mailing Address - Country:US
Mailing Address - Phone:714-512-0918
Mailing Address - Fax:
Practice Address - Street 1:2111 LANDMARK CIR NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1967
Practice Address - Country:US
Practice Address - Phone:701-858-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR40595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily