Provider Demographics
NPI:1275261521
Name:KYROUAC, KATHERINE WIED (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WIED
Last Name:KYROUAC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 US HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-3845
Mailing Address - Country:US
Mailing Address - Phone:318-366-3863
Mailing Address - Fax:
Practice Address - Street 1:413 US HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-3845
Practice Address - Country:US
Practice Address - Phone:318-366-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089381363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner