Provider Demographics
NPI:1245461276
Name:STARKS, KATIE NICOLE FINNERTY (MD, MS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:NICOLE FINNERTY
Last Name:STARKS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:FINNERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:1201 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4413
Mailing Address - Country:US
Mailing Address - Phone:817-332-2020
Mailing Address - Fax:817-332-4797
Practice Address - Street 1:1201 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4413
Practice Address - Country:US
Practice Address - Phone:817-332-2020
Practice Address - Fax:817-332-4797
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5627207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
296185YUPBOtherMEDICARE PTAN
TX296185ZHSFOtherMEDICARE PTAN