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NPI Code Detail

MEDICARE: KATELYN LOUCKS

MEDICARE: KATELYN LOUCKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner407121NY

General Provider Information

NPI Number : 1164354965
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN LOUCKS
Provider Business Mailing Address
First Line : 300 CRITTENDEN BOULEVARD
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 CRITTENDEN BOULEVARD
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-275-8686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ KATELYN LOUCKS ” Practice Location

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