MEDICARE: MRS. KATELYN ANN O'GORMAN FNP-BC

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	363L00000X	Nurse Practitioner	SP033994	PA
2	363LF0000X	Family Nurse Practitioner	SP033994	PA

General Provider Information

NPI Number	:	1427927359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATELYN ANN O'GORMAN FNP-BC

Provider Business Mailing Address
First Line	:	237 LAUREL DR
Second Line	:
City	:	SUMMIT HILL
State	:	PA
Zip	:	18250-1705
Country	:	US
Telephone Number	:	484-862-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 BLAKESLEE BOULEVARD DR E
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2404
Country	:	US
Telephone Number	:	484-224-9300
Fax Number	:

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	12/09/2025

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