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General NPI Number Information
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NPI Number | 1184277444
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Entity Type | Individual
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Provider Name | KATELYN MARIE ROTH MSN APRN AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1500 RED RIVER ST
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City | AUSTIN
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State | TX
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Zip | 78701-1918
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Country | US
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Telephone | 512-324-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 LINDEN ST BLDG 1
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City | AUSTIN
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State | TX
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Zip | 78702-3045
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Country | US
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Telephone | 763-438-3544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 30810
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License Number State | TX
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