Provider Demographics
NPI:1205446457
Name:ELDRIDGE, KATELYN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:ELDRIDGE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:E
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-794-5988
Mailing Address - Fax:423-232-8583
Practice Address - Street 1:121 BOONE RIDGE DR STE 1004
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4993
Practice Address - Country:US
Practice Address - Phone:423-794-5988
Practice Address - Fax:423-232-8583
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant