Healthcare Provider Details

I. General information

NPI: 1255942942
Provider Name (Legal Business Name): KATHERINE TOWNSEND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 07/25/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HARRY HINES BLVD
DALLAS TX
75235-5202
US

IV. Provider business mailing address

6911 SOUTHRIDGE DR
DALLAS TX
75214-3247
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone: 318-471-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1126619
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number211543
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: