MEDICARE: KATHERINE ANNA NACK APRN

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	363L00000X	Nurse Practitioner	899820	TX
2	363LC0200X	Critical Care Medicine Nurse Practitioner	899820	TX

General Provider Information

NPI Number	:	1356940837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNA NACK APRN

Provider Business Mailing Address
First Line	:	601 OMEGA DR STE 208
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2075
Country	:	US
Telephone Number	:	817-465-5881
Fax Number	:	817-465-6336

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY STE 285
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4127
Country	:	US
Telephone Number	:	817-263-5864
Fax Number	:	817-263-3791

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	04/01/2021

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