Provider Demographics
NPI:1801123765
Name:GAYLORD, KATHRYN M (PMH-CNS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:PMH-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 ROMPEL OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4252
Mailing Address - Country:US
Mailing Address - Phone:210-332-5186
Mailing Address - Fax:
Practice Address - Street 1:3400 ROWLEY E. CHAMBERS AVENUE
Practice Address - Street 2:UNITED STATES ARMY INSTITUTE OF SURGICAL RESEARCH
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6315
Practice Address - Country:US
Practice Address - Phone:210-916-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCNS-1713364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult