Healthcare Provider Details

I. General information

NPI: 1275618274
Provider Name (Legal Business Name): KATHRYN DESHOTELS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14006 OLD HIGHWAY 59 N
SPLENDORA TX
77372-6302
US

IV. Provider business mailing address

PO BOX 62230
HOUSTON TX
77205-2230
US

V. Phone/Fax

Practice location:
  • Phone: 281-689-2605
  • Fax: 281-689-2259
Mailing address:
  • Phone: 281-364-8373
  • Fax: 866-234-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number649195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: