Provider Demographics
NPI:1225108913
Name:GOMEZ-FLAMING, KATHRYN MONICA (RN, FNPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MONICA
Last Name:GOMEZ-FLAMING
Suffix:
Gender:F
Credentials:RN, FNPC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, FNPC
Mailing Address - Street 1:199 PINE POST CV
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4443
Mailing Address - Country:US
Mailing Address - Phone:512-829-5304
Mailing Address - Fax:
Practice Address - Street 1:199 PINE POST CV
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-4443
Practice Address - Country:US
Practice Address - Phone:512-829-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS82306Medicare UPIN