Healthcare Provider Details

I. General information

NPI: 1548107295
Provider Name (Legal Business Name): KATELYN NICOLE ALVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ALVERSON

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 LONG BEACH BLVD STE 200
LONG BEACH CA
90806-1513
US

IV. Provider business mailing address

2777 LONG BEACH BLVD STE 200
LONG BEACH CA
90806-1513
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5653
  • Fax:
Mailing address:
  • Phone: 562-595-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95039419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: