National Provider Identifier
Katelyn Elizabeth Johnson-Clark, D.O.
Katelyn Elizabeth Johnson-Clark, D.O. is listed in the NPPES registry with a primary specialty of Pediatrics Physician in Ellicottville, NY and a listed phone number of (716) 257-4397.
Profile Overview
- NPI
- 1285890939
- Provider Type
- Individual
- Primary Specialty
- Pediatrics Physician
- Enumeration Date
- August 01, 2008
- Last Updated
- September 03, 2025
Practice Location
- 5 Park Sq
- Ellicottville, NY 14731-7014
Phone: (716) 257-4397
Mailing Address
- PO Box 1252
- Ellicottville, NY 14731-1252
Specialties
- Pediatrics Physician (208000000X)
Full Record
- NPI
- 1285890939
- Entity Type
- Individual
- Last Name
- Johnson-Clark
- First Name
- Katelyn
- Middle Name
- Elizabeth
- Name Prefix
- Dr.
- Credential
- D.O.
- Provider Other Last Name
- Clark
- Provider Other First Name
- Katelyn
- Provider Other Middle Name
- Elizabeth
- Provider Other Name Prefix Text
- Dr.
- Provider Other Credential Text
- D.O.
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- PO Box 1252
- Mailing City
- Ellicottville
- Mailing State
- NY
- Mailing ZIP Code
- 14731-1252
- Mailing Country
- US
- Mailing Phone
- (941) 441-7804
- Mailing Fax
- (681) 230-8216
- Practice Street Address
- 5 Park Sq
- Practice City
- Ellicottville
- Practice State
- NY
- Practice ZIP Code
- 14731-7014
- Practice Country
- US
- Practice Phone
- (716) 257-4397
- Practice Fax
- (681) 230-8216
- Enumeration Date
- August 01, 2008
- Last Updated
- September 03, 2025
- Sex
- Female
- Sole Proprietor
- Yes
- Certification Date
- September 03, 2025
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pediatrics Physician (208000000X)