MEDICARE: KATHRYN LEE MAZZELLA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15399100	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70091888	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95035151	CA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704439379	MI
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	888637	NV
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1203370	TX
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	326830	AZ
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0041332	OH
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024196455	VA
10	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11034602	FL
11	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	246018	LA

General Provider Information

NPI Number	:	1063239879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN LEE MAZZELLA PMHNP-BC

Provider Business Mailing Address
First Line	:	12316 THRASHER AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-0669
Country	:	US
Telephone Number	:	727-808-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	12316 THRASHER AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-0669
Country	:	US
Telephone Number	:	727-808-3032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	05/22/2026

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