Katelyn Poulsen, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

282584 Issued in AZ

Practice address

15778 W Yuma Rd
Goodyear, AZ 85338-3358

Phone

(623) 932-7500

NPI assigned

Mar 1, 2023

Last updated

Mar 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Katelyn Poulsen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1598464364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15778 W YUMA RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853383358",
            "telephone_number": "623-932-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15778 W YUMA RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853383358",
            "telephone_number": "623-932-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "KATELYN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "282584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "POULSEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christopher Gordon Porter, DNP
• Gillian Porter, PT
• Isabel Armenta Portillo
• Janessa Portillo
• Zolie M Potter, LMHCA
• Susan Powell
• Lydia Powers, DO
• Patricia A Powlis
• Practihealth, LLC (East Wind Pain and Wellness)
• Praise Enterprises LLC

• Licensed Practical Nurse in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.