Provider Demographics
NPI:1154831956
Name:KNOWLTON, CATELYN ROSE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CATELYN
Middle Name:ROSE
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CATELYN
Other - Middle Name:ROSE
Other - Last Name:PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 FM 1764 RD STE 190
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2826
Mailing Address - Country:US
Mailing Address - Phone:281-886-8964
Mailing Address - Fax:409-440-8071
Practice Address - Street 1:2600 FM 1764 RD STE 190
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-2826
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:409-440-8071
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP135331OtherBOARD OF NURSING