Provider Demographics
NPI:1790511830
Name:GIST, KATELYN NEAL (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:NEAL
Last Name:GIST
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3319
Mailing Address - Country:US
Mailing Address - Phone:270-465-3561
Mailing Address - Fax:
Practice Address - Street 1:219 MEADER ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2639
Practice Address - Country:US
Practice Address - Phone:270-789-6158
Practice Address - Fax:270-789-6171
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2025-10-30
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Provider Licenses
StateLicense IDTaxonomies
KYTC023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant