Provider Demographics
NPI:1356236640
Name:FERNANDEZ, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 OLMSTEAD DR APT 69
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2109
Mailing Address - Country:US
Mailing Address - Phone:912-255-9930
Mailing Address - Fax:
Practice Address - Street 1:901 OLMSTEAD DR APT 69
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2109
Practice Address - Country:US
Practice Address - Phone:912-255-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25108443171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor