Healthcare Provider Details

I. General information

NPI: 1235990037
Provider Name (Legal Business Name): KATELYN ELIZABETH FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 HIGHWAY 90
PACE FL
32571-2066
US

IV. Provider business mailing address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

V. Phone/Fax

Practice location:
  • Phone: 850-304-0390
  • Fax: 850-304-0392
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: