Healthcare Provider Details

I. General information

NPI: 1215936513
Provider Name (Legal Business Name): KATHY L BAINBRIDGE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 WINSOR CT
BROOKELAND TX
75931-5692
US

IV. Provider business mailing address

321 WINSOR CT
BROOKELAND TX
75931-5692
US

V. Phone/Fax

Practice location:
  • Phone: 915-229-0331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP115445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: