Provider Demographics
NPI:1144827072
Name:STULTS, KATELYN AMANDA (NP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:AMANDA
Last Name:STULTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18316 TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5450
Mailing Address - Country:US
Mailing Address - Phone:610-513-8182
Mailing Address - Fax:
Practice Address - Street 1:3742 KATELLA AVE STE 302
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3172
Practice Address - Country:US
Practice Address - Phone:562-702-3825
Practice Address - Fax:323-302-4581
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily