MEDICARE: DR. KATHERINE MARIE CHURCHWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP135236	TX

General Provider Information

NPI Number	:	1154834323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE MARIE CHURCHWELL

Provider Business Mailing Address
First Line	:	PO BOX 35629
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0629
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:	214-231-2159

Provider Business Practice Location Address
First Line	:	4453 MAIN ST STE 320
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4431
Country	:	US
Telephone Number	:	469-649-9911
Fax Number	:	469-947-6114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	09/18/2025

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