Healthcare Provider Details

I. General information

NPI: 1588418404
Provider Name (Legal Business Name): KATELYN DANIELLE WALPOLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax: 623-547-1899
Mailing address:
  • Phone: 623-547-2600
  • Fax: 623-547-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.268180
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.439689
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number268180
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: