Healthcare Provider Details

I. General information

NPI: 1174212427
Provider Name (Legal Business Name): KATY BLY CAULFIELD AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 HUEBNER RD STE 202
SAN ANTONIO TX
78240-1776
US

IV. Provider business mailing address

7947 COLONIAL WOODS
BOERNE TX
78015-5001
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0303
  • Fax: 210-651-0302
Mailing address:
  • Phone: 210-414-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1115957
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1115957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: