Provider Demographics
NPI:1750181475
Name:MANLEY, KATELIN (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:MANLEY
Suffix:
Gender:
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BOGI ST
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-2031
Mailing Address - Country:US
Mailing Address - Phone:432-853-6202
Mailing Address - Fax:
Practice Address - Street 1:32685 US HIGHWAY 281 N STE 181
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3274
Practice Address - Country:US
Practice Address - Phone:830-433-7210
Practice Address - Fax:830-433-7250
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily