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General NPI Number Information
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NPI Number | 1689710212
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Entity Type | Individual
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Provider Name | MOLLY KATHRYN AUGUSTINE M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 1205 S WHITE CHAPEL BLVD STE 285
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9331
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Country | US
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Telephone | 817-527-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 504 POTOMAC PL
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9317
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Country | US
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Telephone | 443-392-5561
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R2809
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License Number State | TX
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