Provider Demographics
NPI:1730710641
Name:ANDERSON, KATHERINE SHEPHERD (ACNP- BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SHEPHERD
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ACNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 COLLINS PATH
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7325
Mailing Address - Country:US
Mailing Address - Phone:703-485-6110
Mailing Address - Fax:
Practice Address - Street 1:2205 COLLINS PATH
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7325
Practice Address - Country:US
Practice Address - Phone:703-485-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001890363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care