Healthcare Provider Details

I. General information

NPI: 1205446457
Provider Name (Legal Business Name): KATELYN ELIZABETH ELDRIDGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN E WATTS PA-C

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 ASHTON AVE
MOUNT JULIET TN
37122-1516
US

IV. Provider business mailing address

112 SPARKS DR
FOREST CITY NC
28043-9021
US

V. Phone/Fax

Practice location:
  • Phone: 828-351-6000
  • Fax: 828-287-7436
Mailing address:
  • Phone: 704-675-7279
  • Fax: 704-675-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: