MEDICARE: KATHERINE ANN KUNKLE MSN, APRN, FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	1015314	TX
2	363LF0000X	Family Nurse Practitioner	1015314	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942830211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN KUNKLE MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1809 N CARLSBAD LN
Second Line	:
City	:	DEER PARK
State	:	TX
Zip	:	77536-6080
Country	:	US
Telephone Number	:	281-299-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 MAIN ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4252
Country	:	US
Telephone Number	:	713-946-7461
Fax Number	:

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

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	05/02/2022

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