Provider Demographics
NPI:1144203431
Name:LANDHERR, KATHRYN MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE
Last Name:LANDHERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 RENFERT WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5654
Mailing Address - Country:US
Mailing Address - Phone:512-451-8211
Mailing Address - Fax:512-452-4095
Practice Address - Street 1:12200 RENFERT WAY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5654
Practice Address - Country:US
Practice Address - Phone:512-451-8211
Practice Address - Fax:512-495-4095
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628878Medicaid
AZH41178Medicare UPIN
AZ628878Medicaid