MEDICARE: MRS. KATHRYN ANN JORGENSEN CRNP

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	363LF0000X	Family Nurse Practitioner	769553	TX

General Provider Information

NPI Number	:	1770857724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN ANN JORGENSEN CRNP

Provider Business Mailing Address
First Line	:	1618 BREEZY BEND DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 BREEZY BEND DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6109
Country	:	US
Telephone Number	:	281-712-8152
Fax Number	:

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

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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