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General NPI Number Information
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NPI Number | 1700207495
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Entity Type | Individual
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Provider Name | KATY BAGWILL CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 2000 E LAMAR BLVD
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City | ARLINGTON
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State | TX
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Zip | 76006-7346
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Country | US
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Telephone | 940-531-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ROSALIND REDFERN GROVER PKWY
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City | MIDLAND
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State | TX
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Zip | 79701-5846
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Country | US
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Telephone | 432-221-1111
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 780188
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP124920
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License Number State | TX
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