Provider Demographics
NPI:1235125600
Name:STEPHENS, KATHRYN BISHOP (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:BISHOP
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:BISHOP
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13130 BLANCO RD APT 501
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2166
Mailing Address - Country:US
Mailing Address - Phone:865-310-7129
Mailing Address - Fax:
Practice Address - Street 1:13130 BLANCO RD APT 501
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2166
Practice Address - Country:US
Practice Address - Phone:865-310-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23996174400000X
TXP8735208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3071715Medicaid
TN0148861OtherBCBS
TN3071715Medicaid