Provider Demographics
NPI:1578084091
Name:HALE, KATELYNE M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYNE
Middle Name:M
Last Name:HALE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATELYNE
Other - Middle Name:M
Other - Last Name:COTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:661 INDEPENDENCE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5114
Practice Address - Country:US
Practice Address - Phone:757-547-0798
Practice Address - Fax:757-547-0145
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-02-27
Deactivation Date:2019-09-25
Deactivation Code:
Reactivation Date:2019-10-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant