Healthcare Provider Details

I. General information

NPI: 1821551185
Provider Name (Legal Business Name): KATELYN SWANSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

PSC 482 BOX 1600
FPO AP
96362-0017
US

V. Phone/Fax

Practice location:
  • Phone: 812-972-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0102206455
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: