Provider Demographics
NPI:1982340048
Name:O'CONNOR, KATELYN SCOTT
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:SCOTT
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 LOFTYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7225
Mailing Address - Country:US
Mailing Address - Phone:785-766-5063
Mailing Address - Fax:
Practice Address - Street 1:2729 LOFTYVIEW DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7225
Practice Address - Country:US
Practice Address - Phone:785-766-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant