Healthcare Provider Details

I. General information

NPI: 1649640756
Provider Name (Legal Business Name): KATHERINE POWERS GONZALEZ AG-ACNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N STATE HIGHWAY 118
ALPINE TX
79830-2002
US

IV. Provider business mailing address

2600 N STATE HIGHWAY 118
ALPINE TX
79830-2002
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-0430
  • Fax:
Mailing address:
  • Phone: 214-208-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP129217
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: