Healthcare Provider Details

I. General information

NPI: 1215831508
Provider Name (Legal Business Name): KATELYN HARRIS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 RANDOLPH ST APT 3
BEDFORD VA
24523-1341
US

IV. Provider business mailing address

809 RANDOLPH ST APT 3
BEDFORD VA
24523-1341
US

V. Phone/Fax

Practice location:
  • Phone: 434-509-7077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: