Healthcare Provider Details

I. General information

NPI: 1871849232
Provider Name (Legal Business Name): KATHERINE M. STRAIGHT RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD SUITE 304
AUSTIN TX
78723-3077
US

IV. Provider business mailing address

11907 BROOKWOOD RD
AUSTIN TX
78750-2744
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number775728
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number775728
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: