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NPI Code Detail

MEDICARE: KATHERINE KELLE TILLMAN APRN ACNS-BC

MEDICARE: KATHERINE KELLE TILLMAN APRN ACNS-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
1163WA2000XAdministrator Registered NurseAP129952TX

General Provider Information

NPI Number : 1720648140
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE KELLE TILLMAN APRN ACNS-BC
Provider Business Mailing Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 817-332-7722
Fax Number : 817-582-4977
Provider Business Practice Location Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 817-332-7722
Fax Number : 817-582-4977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 06/02/2025

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Directions to “ KATHERINE KELLE TILLMAN APRN ACNS-BC” Practice Location

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