Provider Demographics
NPI:1679915383
Name:WANTZ, KATELIN LEE (PA-C)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:LEE
Last Name:WANTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELIN
Other - Middle Name:
Other - Last Name:HOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 FAIRGROVE CHURCH RD SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8680
Mailing Address - Country:US
Mailing Address - Phone:828-855-3636
Mailing Address - Fax:828-855-3638
Practice Address - Street 1:711 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8680
Practice Address - Country:US
Practice Address - Phone:828-855-3636
Practice Address - Fax:828-855-3638
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant