Provider Demographics
NPI:1093711202
Name:ANDERSON, KATHRYN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10434 CHELSEA BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2159
Mailing Address - Country:US
Mailing Address - Phone:281-485-7279
Mailing Address - Fax:
Practice Address - Street 1:10434 CHELSEA BROOK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2159
Practice Address - Country:US
Practice Address - Phone:281-485-7279
Practice Address - Fax:713-527-5689
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX031382163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22429Medicare UPIN