Provider Demographics
NPI:1205445863
Name:ERWIN, KATELYN
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3224
Mailing Address - Country:US
Mailing Address - Phone:417-667-3355
Mailing Address - Fax:
Practice Address - Street 1:627 S ASH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3218
Practice Address - Country:US
Practice Address - Phone:417-448-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020024672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner