MEDICARE: KATHERINE ANN HARRIS CORNELIUS AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	1169610	TX
2	363LA2200X	Adult Health Nurse Practitioner	1169610	TX

General Provider Information

NPI Number	:	1518795467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN HARRIS CORNELIUS AGACNP-BC

Provider Business Mailing Address
First Line	:	4825 DAVIS LN APT 1136
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4572
Country	:	US
Telephone Number	:	607-793-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 DAVIS LN APT 1136
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4572
Country	:	US
Telephone Number	:	607-793-7303
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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