Healthcare Provider Details

I. General information

NPI: 1164505798
Provider Name (Legal Business Name): KATHERINE CANTRELL WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W EAGLE DR
DECATUR TX
76234-3745
US

IV. Provider business mailing address

PO BOX 1655 308 W. ROCK ISLAND
BOYD TX
76023-1655
US

V. Phone/Fax

Practice location:
  • Phone: 940-627-7829
  • Fax: 940-627-7464
Mailing address:
  • Phone: 940-433-5122
  • Fax: 940-433-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number529851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: