Healthcare Provider Details

I. General information

NPI: 1922647890
Provider Name (Legal Business Name): KATELYN MARIE MELARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN MARIE BOYD

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15815 NE 48TH CIR
VANCOUVER WA
98682-5215
US

IV. Provider business mailing address

15815 NE 48TH CIR
VANCOUVER WA
98682-5215
US

V. Phone/Fax

Practice location:
  • Phone: 360-936-1592
  • Fax:
Mailing address:
  • Phone: 360-936-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNUTR.NU.61088083
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61513231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: