Provider Demographics
NPI:1164505798
Name:CANTRELL, KATHERINE (WHCNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1655
Mailing Address - Street 2:308 W. ROCK ISLAND
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-1655
Mailing Address - Country:US
Mailing Address - Phone:940-433-5122
Mailing Address - Fax:940-433-8309
Practice Address - Street 1:1001 W EAGLE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3745
Practice Address - Country:US
Practice Address - Phone:940-627-7829
Practice Address - Fax:940-627-7464
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529851363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX529851OtherLICENSE