Healthcare Provider Details

I. General information

NPI: 1730826959
Provider Name (Legal Business Name): KATELYN ANN MICHELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 1100
OKLAHOMA CITY OK
73102-1015
US

IV. Provider business mailing address

31 IRISH MOSS PL
THE WOODLANDS TX
77381-6609
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-3000
  • Fax: 405-231-3073
Mailing address:
  • Phone: 832-577-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: