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General NPI Number Information
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NPI Number | 1760978969
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Entity Type | Individual
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Provider Name | KATLYN OLIVIA MAUNEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 711 N DEKALB ST
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City | SHELBY
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State | NC
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Zip | 28150-3911
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Country | US
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Telephone | 704-482-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CLINTON ST
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City | SHELBY
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State | NC
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Zip | 28152-8196
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Country | US
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Telephone | 704-472-6073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22042
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5012399
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License Number State | NC
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