Healthcare Provider Details

I. General information

NPI: 1659675874
Provider Name (Legal Business Name): KATIE NICOLE ROLLINS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE NICOLE BARTLETT PHARM.D.

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 491 NORTHERN NAVAJO MEDICAL CENTER
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6001
  • Fax:
Mailing address:
  • Phone: 505-368-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007414
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00007414
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: