Healthcare Provider Details

I. General information

NPI: 1720619406
Provider Name (Legal Business Name): KATELYN DANIELLE MARIE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEMORIAL WAY WESTERN CAROLINA UNIVERSITY
CULLOWHEE NC
28723
US

IV. Provider business mailing address

245 MEMORIAL WAY WESTERN CAROLINA UNIVERSITY
CULLOWHEE NC
28723
US

V. Phone/Fax

Practice location:
  • Phone: 828-227-7495
  • Fax:
Mailing address:
  • Phone: 828-227-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: