MEDICARE: DR. KATELYN OWENSBY

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	183500000X	Pharmacist	24071	NC

General Provider Information

NPI Number	:	1497159123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATELYN OWENSBY

Provider Business Mailing Address
First Line	:	11306 US 70 BUSINESS HWY W
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 US 70 BUSINESS HWY W
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2206
Country	:	US
Telephone Number	:	919-550-3910
Fax Number	:

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

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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