Healthcare Provider Details

I. General information

NPI: 1780926428
Provider Name (Legal Business Name): KATELYN HELEN DEGNER CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN HELEN ELL

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S DURANGO DR STE 100
LAS VEGAS NV
89145-2487
US

IV. Provider business mailing address

4945 ALONDRA DR
LAS VEGAS NV
89118-1128
US

V. Phone/Fax

Practice location:
  • Phone: 702-932-1300
  • Fax:
Mailing address:
  • Phone: 971-732-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: