Provider Demographics
NPI:1407850118
Name:REVELES, KATHRYN ANNE (PNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:REVELES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 WESTWIND DR
Mailing Address - Street 2:STE 310
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1743
Mailing Address - Country:US
Mailing Address - Phone:915-544-2455
Mailing Address - Fax:915-544-3149
Practice Address - Street 1:9870 GATEWAY BLVD N
Practice Address - Street 2:STE B7
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4425
Practice Address - Country:US
Practice Address - Phone:915-751-5245
Practice Address - Fax:915-751-5255
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513440363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5393Medicare ID - Type Unspecified
TXS81218Medicare UPIN