Healthcare Provider Details

I. General information

NPI: 1003435231
Provider Name (Legal Business Name): KATELYN CARLSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 BEECHER XING N
GAHANNA OH
43230-4563
US

IV. Provider business mailing address

1085 BEECHER XING N
GAHANNA OH
43230-4563
US

V. Phone/Fax

Practice location:
  • Phone: 614-741-8300
  • Fax: 614-741-8271
Mailing address:
  • Phone: 614-741-8300
  • Fax: 614-741-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.016471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: