Healthcare Provider Details

I. General information

NPI: 1114853413
Provider Name (Legal Business Name): KATELYN AMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MILLER ST
WINSTON SALEM NC
27103-2508
US

IV. Provider business mailing address

123 KNOLLWOOD DR
STONEVILLE NC
27048-8442
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-3103
  • Fax:
Mailing address:
  • Phone: 336-394-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30005190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: