Provider Demographics
NPI:1215809199
Name:JOY, KATRINA GABRIELLE (RN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:GABRIELLE
Last Name:JOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 HARRISON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7976
Mailing Address - Country:US
Mailing Address - Phone:530-725-9969
Mailing Address - Fax:
Practice Address - Street 1:3079 HARRISON AVE STE D
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7976
Practice Address - Country:US
Practice Address - Phone:530-725-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NVRN95911163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health