Provider Demographics
NPI:1083932818
Name:ROOT, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 E 5TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3346
Mailing Address - Country:US
Mailing Address - Phone:903-596-3500
Mailing Address - Fax:
Practice Address - Street 1:1000 E 5TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3346
Practice Address - Country:US
Practice Address - Phone:903-596-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4701207RA0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine