Basic Information
| Provider Information | |||||||||
| NPI: | 1205803368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEVLY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988168631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096828517 | ||||||||
| FaxNumber: | 5096826131 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988168631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096828517 | ||||||||
| FaxNumber: | 5096826131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SR0400X | AP30007174 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Rehabilitation | 364SP0809X | AP30007174 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult | 101YM0800X | AP30007174 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 9647181 | 05 | WA | MEDICAID |