Provider Demographics
NPI:1316510381
Name:MORRIS, KATELYN PARK (CRNA, RN)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:PARK
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CRNA, RN
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Mailing Address - Street 1:1104 ANGELICA LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8809
Mailing Address - Country:US
Mailing Address - Phone:704-689-1921
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC283443163W00000X
NC6691367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse