Provider Demographics
NPI:1164301511
Name:MAHANA, KATHRYN LISA (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LISA
Last Name:MAHANA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 QUEENS ROW
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-6946
Mailing Address - Country:US
Mailing Address - Phone:409-951-0025
Mailing Address - Fax:
Practice Address - Street 1:113 QUEENS ROW
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-6946
Practice Address - Country:US
Practice Address - Phone:409-951-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1211373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily