Healthcare Provider Details

I. General information

NPI: 1386092245
Provider Name (Legal Business Name): MARY KATHERINE HOTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 CLODUS FIELDS DR
DALLAS TX
75251-2206
US

IV. Provider business mailing address

2015 FM 546
MCKINNEY TX
75069-1272
US

V. Phone/Fax

Practice location:
  • Phone: 972-991-9504
  • Fax:
Mailing address:
  • Phone: 715-797-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number78281-0
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number921167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: