Provider Demographics
NPI:1154792729
Name:WEGFAHRT, KATELYN D (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:D
Last Name:WEGFAHRT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1776
Mailing Address - Country:US
Mailing Address - Phone:609-927-1991
Mailing Address - Fax:609-927-0075
Practice Address - Street 1:24 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1776
Practice Address - Country:US
Practice Address - Phone:609-927-1991
Practice Address - Fax:609-927-0075
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00378500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant