Provider Demographics
NPI:1083341523
Name:HAINES, KATIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 W STATE HIGHWAY 29 STE 5
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6348
Mailing Address - Country:US
Mailing Address - Phone:512-548-5373
Mailing Address - Fax:
Practice Address - Street 1:12701 W STATE HIGHWAY 29 STE 5
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6348
Practice Address - Country:US
Practice Address - Phone:512-548-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily