Provider Demographics
NPI:1043287477
Name:SIDERS, KATHLEEN LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:SIDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 FANNIN ST
Mailing Address - Street 2:STE. #1620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5400
Mailing Address - Country:US
Mailing Address - Phone:713-500-3267
Mailing Address - Fax:713-500-3263
Practice Address - Street 1:7000 FANNIN ST
Practice Address - Street 2:STE. #1620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5400
Practice Address - Country:US
Practice Address - Phone:713-500-3267
Practice Address - Fax:713-500-3263
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX550882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173175403Medicaid
TXP01095316OtherRAILROAD MEDICARE
TX173175401Medicaid
TX173175402Medicaid
TX8B4924Medicare ID - Type Unspecified
TX173175402Medicaid
TXQ11131Medicare UPIN