Healthcare Provider Details

I. General information

NPI: 1699147181
Provider Name (Legal Business Name): DEENA KOTHMANN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY DR E
COLLEGE STATION TX
77840-2661
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 979-361-3300
  • Fax:
Mailing address:
  • Phone: 979-361-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1015344
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: