MEDICARE: KATELYN DEKALB CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	APRN-CRNA222773	GA
2	367500000X	Certified Registered Nurse Anesthetist	192968	TN

General Provider Information

NPI Number	:	1306314224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN DEKALB CRNA

Provider Business Mailing Address
First Line	:	4230 HARDING PIKE STE 435
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-4900
Country	:	US
Telephone Number	:	615-385-3704
Fax Number	:	615-292-1321

Provider Business Practice Location Address
First Line	:	4230 HARDING PIKE STE 435
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-4900
Country	:	US
Telephone Number	:	615-385-3704
Fax Number	:	615-292-1321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	03/05/2026

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