MEDICARE: DR. KATHLEEN ANNE GALLENTINE MD

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	2084P0800X	Psychiatry Physician	F0190	TX

General Provider Information

NPI Number	:	1184623498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN ANNE GALLENTINE MD

Provider Business Mailing Address
First Line	:	5615 KIRBY DR
Second Line	:	SUITE 410
City	:	HOUSTON
State	:	TX
Zip	:	77005-2445
Country	:	US
Telephone Number	:	713-528-9430
Fax Number	:	713-528-9435

Provider Business Practice Location Address
First Line	:	5615 KIRBY DR
Second Line	:	SUITE 410
City	:	HOUSTON
State	:	TX
Zip	:	77005-2445
Country	:	US
Telephone Number	:	713-528-9430
Fax Number	:	713-528-9435

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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