Provider Demographics
NPI:1235175944
Name:MARTINEZ, KATHRYN ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16107 KENSINGTON DR STE 126
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4224
Mailing Address - Country:US
Mailing Address - Phone:281-783-8162
Mailing Address - Fax:713-439-7995
Practice Address - Street 1:1211 HIGHWAY 6
Practice Address - Street 2:SUITE 40
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4941
Practice Address - Country:US
Practice Address - Phone:281-494-7773
Practice Address - Fax:281-494-7796
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525119363LF0000X
TXAP114707363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182931901Medicaid
TX182931901Medicaid
TX8G6682Medicare ID - Type Unspecified
TXQ71407Medicare UPIN