MEDICARE: KATHLEEN LOUISE SIDERS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	550882	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01095316	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043287477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN LOUISE SIDERS FNP

Provider Business Mailing Address
First Line	:	7000 FANNIN ST
Second Line	:	STE. #1620
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-3267
Fax Number	:	713-500-3263

Provider Business Practice Location Address
First Line	:	7000 FANNIN ST
Second Line	:	STE. #1620
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-3267
Fax Number	:	713-500-3263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	10/27/2014

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