Provider Demographics
NPI:1881113496
Name:CLEYPOOL, KATELYN MARIE (DPM)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:CLEYPOOL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 NORTHLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9256
Mailing Address - Country:US
Mailing Address - Phone:616-363-9833
Mailing Address - Fax:
Practice Address - Street 1:6050 NORTHLAND DR NE STE 180
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9258
Practice Address - Country:US
Practice Address - Phone:616-363-9833
Practice Address - Fax:224-220-9743
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2025-07-31
Deactivation Date:2022-03-25
Deactivation Code:
Reactivation Date:2022-04-18
Provider Licenses
StateLicense IDTaxonomies
MI5901400565213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty