Provider Demographics
NPI:1275618274
Name:DESHOTELS, KATHRYN (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DESHOTELS
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:PO BOX 62230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-2230
Mailing Address - Country:US
Mailing Address - Phone:281-364-8373
Mailing Address - Fax:866-234-8707
Practice Address - Street 1:14006 OLD HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-6302
Practice Address - Country:US
Practice Address - Phone:281-689-2605
Practice Address - Fax:281-689-2259
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11955914OtherTX DRIVERS LICENSE