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NPI Code Detail

MEDICARE: KATHERINE KENNEDY CPNP

MEDICARE: KATHERINE KENNEDY CPNP
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 Practitioner568008TX

General Provider Information

NPI Number : 1972788511
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE KENNEDY CPNP
Provider Business Mailing Address
First Line : PO BOX 841969
Second Line :
City : DALLAS
State : TX
Zip : 75284-1969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4545 RESEARCH FOREST DR
Second Line : SUITE A
City : THE WOODLANDS
State : TX
Zip : 77381-4231
Country : US
Telephone Number : 281-367-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2008
Last Update Date : 07/09/2008

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