Provider Demographics
NPI:1689289357
Name:NEUFELD, KATELYN (NP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:NEUFELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 TREMONT ST W
Mailing Address - Street 2:STE 200
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3743
Mailing Address - Country:US
Mailing Address - Phone:360-876-2434
Mailing Address - Fax:360-876-2696
Practice Address - Street 1:463 TREMONT ST W
Practice Address - Street 2:STE 200
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3743
Practice Address - Country:US
Practice Address - Phone:360-876-2434
Practice Address - Fax:360-876-2696
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61091733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily