MEDICARE: MS. KATHERINE ELISE TAYLOR PEARSON RN

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	163W00000X	Registered Nurse	616645	TX

General Provider Information

NPI Number	:	1205891074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE ELISE TAYLOR PEARSON RN

Provider Business Mailing Address
First Line	:	31735 RETAMA RDG
Second Line	:
City	:	BULVERDE
State	:	TX
Zip	:	78163-4144
Country	:	US
Telephone Number	:	210-787-6943
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 BROADWAY ST # CPO300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6318
Country	:	US
Telephone Number	:	210-787-6943
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/20/2017

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