Provider Demographics
NPI:1760012256
Name:KOONCE, KATHERINE JOELLA (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOELLA
Last Name:KOONCE
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 1:3908 PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7914
Mailing Address - Country:US
Mailing Address - Phone:817-908-2812
Mailing Address - Fax:
Practice Address - Street 1:3455 LOCKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5745
Practice Address - Country:US
Practice Address - Phone:817-336-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily