MEDICARE: DR. KATIE NICOLE FINNERTY STARKS M.D., M.S.

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	207W00000X	Ophthalmology Physician	P5627	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	296185YUPB	OTHER		MEDICARE PTAN
2	296185ZHSF	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1245461276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE NICOLE FINNERTY STARKS M.D., M.S.

Provider Business Mailing Address
First Line	:	1201 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4413
Country	:	US
Telephone Number	:	817-332-2020
Fax Number	:	817-332-4797

Provider Business Practice Location Address
First Line	:	1201 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4413
Country	:	US
Telephone Number	:	817-332-2020
Fax Number	:	817-332-4797

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

Provider Enumeration Date	:	08/08/2009
Last Update Date	:	11/22/2021

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