Healthcare Provider Details

I. General information

NPI: 1932065901
Provider Name (Legal Business Name): KATIE NICOLE LAYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JOERSCHKE DR STE A
GRASS VALLEY CA
95945-5259
US

IV. Provider business mailing address

10359 CAREY DR
GRASS VALLEY CA
95945-4818
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-6885
  • Fax:
Mailing address:
  • Phone: 530-264-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number03606259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: