Individual
KATELYN NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 SW 4TH AVE STE 105, ONTARIO, OR 97914-2638
(418) 892-6685
(541) 889-2997
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9279
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA217656
OR
363A00000X
Physician Assistant
PA2694
ID
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500830651
—
OR
Enumeration date
06/13/2022
Last updated
01/14/2026
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