Healthcare Provider Details

I. General information

NPI: 1295090454
Provider Name (Legal Business Name): KATHERINE LUSK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 MAIN ST
CHAPPELL HILL TX
77426-6247
US

IV. Provider business mailing address

2800 RUNNING RIVER LN
WASHINGTON TX
77880-6678
US

V. Phone/Fax

Practice location:
  • Phone: 214-205-7238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ5022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: