Provider Demographics
NPI:1730813965
Name:PHILLIPS, KATELYN GALLOWAY (NP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:GALLOWAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:608 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1204
Mailing Address - Country:US
Mailing Address - Phone:704-840-8795
Mailing Address - Fax:
Practice Address - Street 1:969 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3455
Practice Address - Country:US
Practice Address - Phone:704-866-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty