Provider Demographics
NPI:1407589534
Name:ULVERSOY, CATESBY PENN (PA)
Entity type:Individual
Prefix:
First Name:CATESBY
Middle Name:PENN
Last Name:ULVERSOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CATESBY
Other - Middle Name:
Other - Last Name:PENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4721 CHACE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3700
Mailing Address - Country:US
Mailing Address - Phone:205-716-6054
Mailing Address - Fax:205-823-5218
Practice Address - Street 1:4721 CHACE CIR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3700
Practice Address - Country:US
Practice Address - Phone:205-716-6054
Practice Address - Fax:205-823-5218
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11104363A00000X
363A00000X
AL2195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty