Provider Demographics
NPI:1164000360
Name:GRIFFIN, KATIE-LYNN
Entity Type:Individual
Prefix:
First Name:KATIE-LYNN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 JADE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1132
Mailing Address - Country:US
Mailing Address - Phone:409-718-8077
Mailing Address - Fax:
Practice Address - Street 1:6033 JADE AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1132
Practice Address - Country:US
Practice Address - Phone:409-718-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-09-24
Deactivation Date:2021-09-01
Deactivation Code:
Reactivation Date:2021-09-23
Provider Licenses
StateLicense IDTaxonomies
TX305098164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse