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
Phone: (541) 222-8333
Fax: (541) 222-8320
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366732729 | NPPES |
| Oregon | MEDICAID | 500654943 |
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