Provider Demographics
NPI:1205803368
Name:HEVLY, KATHERINE (APNP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:HEVLY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8631
Mailing Address - Country:US
Mailing Address - Phone:509-682-8517
Mailing Address - Fax:509-682-6131
Practice Address - Street 1:503 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8631
Practice Address - Country:US
Practice Address - Phone:509-682-8517
Practice Address - Fax:509-682-6131
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007174364SR0400X, 364SP0809X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647181Medicaid
WA9647181Medicaid