Provider Demographics
NPI:1255009643
Name:MIMS, KATRINA (CPT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MIMS
Suffix:
Gender:F
Credentials:CPT
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 6167
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77491-6167
Mailing Address - Country:US
Mailing Address - Phone:832-756-3326
Mailing Address - Fax:
Practice Address - Street 1:2530 PINES POINTE DR.
Practice Address - Street 2:KATY
Practice Address - City:TEXAS
Practice Address - State:TX
Practice Address - Zip Code:77493
Practice Address - Country:US
Practice Address - Phone:832-756-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other