MEDICARE: KATELYN MICHELLE MCGOWAN FNP

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	363LF0000X	Family Nurse Practitioner	352271	NY

General Provider Information

NPI Number	:	1902587835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MICHELLE MCGOWAN FNP

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 STATE ROUTE 67
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-3695
Country	:	US
Telephone Number	:	518-451-7520
Fax Number	:	518-621-5674

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	04/08/2026

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