Provider Demographics
NPI:1144455643
Name:STEELE, KATHERINE LONG (FNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LONG
Last Name:STEELE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868 WYNBROOKE CV
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6302
Mailing Address - Country:US
Mailing Address - Phone:770-469-1572
Mailing Address - Fax:
Practice Address - Street 1:6868 WYNBROOKE CV
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6302
Practice Address - Country:US
Practice Address - Phone:770-469-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner