Provider Demographics
NPI:1962214460
Name:ADAMS, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ADAMS
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:POLK
Mailing Address - State:NE
Mailing Address - Zip Code:68654-0052
Mailing Address - Country:US
Mailing Address - Phone:308-390-7081
Mailing Address - Fax:
Practice Address - Street 1:170 SOUTH HICKORY ST
Practice Address - Street 2:PO BOX 52
Practice Address - City:POLK
Practice Address - State:NE
Practice Address - Zip Code:68654-0052
Practice Address - Country:US
Practice Address - Phone:308-390-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant