Provider Demographics
NPI:1902317118
Name:VITEK, KATHERINE (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VITEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ALEXANDRA
Other - Last Name:VITEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1737 BRIARCREST DR STE 14
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2739
Mailing Address - Country:US
Mailing Address - Phone:979-776-4777
Mailing Address - Fax:979-776-0588
Practice Address - Street 1:1737 BRIARCREST DR STE 14
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2739
Practice Address - Country:US
Practice Address - Phone:979-776-4777
Practice Address - Fax:979-776-0588
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137729367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered