Healthcare Provider Details

I. General information

NPI: 1417505595
Provider Name (Legal Business Name): KATHRYN SHEPPERD MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 COUNTRY SIDE DR
SAN ANTONIO TX
78209-2234
US

IV. Provider business mailing address

8210 COUNTRY SIDE DR
SAN ANTONIO TX
78209-2234
US

V. Phone/Fax

Practice location:
  • Phone: 210-317-4771
  • Fax:
Mailing address:
  • Phone: 210-317-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP139643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: