Healthcare Provider Details

I. General information

NPI: 1457854267
Provider Name (Legal Business Name): KATHY SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 03/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S MAIN ST
FORT WORTH TX
76104-1224
US

IV. Provider business mailing address

219 S MAIN ST
FORT WORTH TX
76104-1224
US

V. Phone/Fax

Practice location:
  • Phone: 817-265-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number761775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: