Healthcare Provider Details

I. General information

NPI: 1720632003
Provider Name (Legal Business Name): KATELYN BRIANNE BRESEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 AIRPORT ROAD
ANAHUAC TX
77514
US

IV. Provider business mailing address

528 CEDAR AVE
WINNIE TX
77665-8868
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-2730
  • Fax: 409-267-3099
Mailing address:
  • Phone: 409-659-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141967
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: