Provider Demographics
NPI:1194585323
Name:WARD, KATELYN MICHELLE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MICHELLE
Last Name:WARD
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 1:32 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8926
Mailing Address - Country:US
Mailing Address - Phone:740-352-5913
Mailing Address - Fax:
Practice Address - Street 1:32 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8926
Practice Address - Country:US
Practice Address - Phone:740-352-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver