Provider Demographics
NPI:1356684534
Name:LUNDEGREEN, KATHY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:LUNDEGREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79108-5801
Mailing Address - Country:US
Mailing Address - Phone:806-678-9120
Mailing Address - Fax:
Practice Address - Street 1:5209 BOYD ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79108-5801
Practice Address - Country:US
Practice Address - Phone:806-678-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572684163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse