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NPI Code Detail

MEDICARE: KATHRYN ANNE REVELES P.N.P.

MEDICARE: KATHRYN ANNE REVELES P.N.P.
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
1363LP0200XPediatric Nurse Practitioner513440TX

General Provider Information

NPI Number : 1407850118
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN ANNE REVELES P.N.P.
Provider Business Mailing Address
First Line : 7100 WESTWIND DR
Second Line : STE 310
City : EL PASO
State : TX
Zip : 79912-1743
Country : US
Telephone Number : 915-544-2455
Fax Number : 915-544-3149
Provider Business Practice Location Address
First Line : 9870 GATEWAY BLVD N
Second Line : STE B7
City : EL PASO
State : TX
Zip : 79924-4425
Country : US
Telephone Number : 915-751-5245
Fax Number : 915-751-5255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/08/2007

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Directions to “ KATHRYN ANNE REVELES P.N.P.” Practice Location

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