Healthcare Provider Details

I. General information

NPI: 1003791336
Provider Name (Legal Business Name): KATHRYN ELIZABETH WHITACRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 FARM VALLEY DR 500
BOERNE TX
78006
US

IV. Provider business mailing address

9222 FISHERS HILL DR
SAN ANTONIO TX
78240-2838
US

V. Phone/Fax

Practice location:
  • Phone: 830-249-9328
  • Fax:
Mailing address:
  • Phone: 830-481-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number1128597
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: