Provider Demographics
NPI:1750729125
Name:VAN PELT, KATRINA (DO)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:VAN PELT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:637 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4509
Mailing Address - Country:US
Mailing Address - Phone:901-222-4600
Mailing Address - Fax:
Practice Address - Street 1:637 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4509
Practice Address - Country:US
Practice Address - Phone:901-222-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO3248207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology