Clark, Katelyn Ann

Clark, Katelyn Ann is an sole proprietor health care provider with primary practice located at Peacehealth Surgical Specialties 3355 Riverbend Dr., Suite 300, Springfield OR 97477. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Clark, Katelyn Ann can be contacted via phone (541) 222-8333.

Contact Information

Primary practice address
Peacehealth Surgical Specialties 3355 Riverbend Dr., Suite 300 Springfield OR 97477
Fax: (541) 222-8320
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X MD175116 Oregon

Profile Details

NPI number 1366732729
LBN Legal business name Clark, Katelyn Ann
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 19th, 2011
Last updated Feb 28th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366732729 NPPES
Oregon MEDICAID 500654943

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