MEDICARE: KATELYN MAE DUNN APRN-CNP, 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	163WP0808X	Psychiatric/Mental Health Registered Nurse	869320	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1129831	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	34799	TN

General Provider Information

NPI Number	:	1457060329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MAE DUNN APRN-CNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	7120 NEILLS BRANCH DR
Second Line	:
City	:	COLLEGE GROVE
State	:	TN
Zip	:	37046-1491
Country	:	US
Telephone Number	:	832-687-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 NEILLS BRANCH DR
Second Line	:
City	:	COLLEGE GROVE
State	:	TN
Zip	:	37046-1491
Country	:	US
Telephone Number	:	832-687-5976
Fax Number	:

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

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	09/29/2023

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