Provider Demographics
NPI:1235578592
Name:MEDFORD, KATHRYN ESTELLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ESTELLE
Last Name:MEDFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2746
Mailing Address - Country:US
Mailing Address - Phone:806-743-9355
Mailing Address - Fax:806-743-9363
Practice Address - Street 1:1950 ASPEN AVE # 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-1211
Practice Address - Country:US
Practice Address - Phone:806-740-1400
Practice Address - Fax:806-740-1440
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577973363LF0000X
TXAP110395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily