Healthcare Provider Details

I. General information

NPI: 1043139991
Provider Name (Legal Business Name): KATHERINE HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S LUMPKIN ST
ATHENS GA
30606-4739
US

IV. Provider business mailing address

1040 SKIPSTONE PT
WATKINSVILLE GA
30677-2274
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4825851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: