Healthcare Provider Details

I. General information

NPI: 1013811280
Provider Name (Legal Business Name): KATELYN WATTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W 820 N
SANTAQUIN UT
84655-5713
US

IV. Provider business mailing address

58 W 820 N
SANTAQUIN UT
84655-5713
US

V. Phone/Fax

Practice location:
  • Phone: 901-995-8076
  • Fax:
Mailing address:
  • Phone: 901-995-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10270108-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: