Healthcare Provider Details

I. General information

NPI: 1467180497
Provider Name (Legal Business Name): KATHERINE AHLSTROM CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEMORIAL DR
BRYAN TX
77802-5205
US

IV. Provider business mailing address

1500 UNIVERSITY DR E STE 100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-731-4520
  • Fax: 979-731-4570
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1084428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: