Provider Demographics
NPI:1093098691
Name:HOPKINS, KATHERINE LACEY (CNM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LACEY
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LACEY
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CNM
Mailing Address - Street 1:1300 W TERRELL AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2822
Mailing Address - Country:US
Mailing Address - Phone:817-250-7360
Mailing Address - Fax:
Practice Address - Street 1:1300 W TERRELL AVE STE 320
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2822
Practice Address - Country:US
Practice Address - Phone:817-250-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120570367A00000X
TX741638367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287664102Medicaid
TX890N04OtherBCBS
TX890N04OtherBCBS