Healthcare Provider Details

I. General information

NPI: 1962935080
Provider Name (Legal Business Name): KATELYN R FREEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 115 PMB# 244468
PHOENIX AZ
85016-7849
US

IV. Provider business mailing address

2942 N 24TH ST STE 115 PMB# 244468
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 406-570-1611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5380385101
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP9815
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112619
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: