Healthcare Provider Details

I. General information

NPI: 1891479788
Provider Name (Legal Business Name): KATELYN DIANE WARREN DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 BAPTIST HEALTH DR STE 600
LITTLE ROCK AR
72205-6231
US

IV. Provider business mailing address

9501 BAPTIST HEALTH DR STE 600
LITTLE ROCK AR
72205-6231
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number224750
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: