Provider Demographics
NPI:1205430105
Name:MCSKANE, KATELYN JEAN (FNP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JEAN
Last Name:MCSKANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JEAN
Other - Last Name:MCSKANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:24910 LAS BRISAS RD STE 121
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4035
Mailing Address - Country:US
Mailing Address - Phone:888-873-6220
Mailing Address - Fax:
Practice Address - Street 1:24910 LAS BRISAS RD STE 121
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4035
Practice Address - Country:US
Practice Address - Phone:888-873-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily