Provider Demographics
NPI:1437120128
Name:MACNAK, KATHY (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MACNAK
Suffix:
Gender:F
Credentials:MSN, FNP
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 1531
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1531
Mailing Address - Country:US
Mailing Address - Phone:574-253-1728
Mailing Address - Fax:832-559-8514
Practice Address - Street 1:888 GRAHAM DR
Practice Address - Street 2:STE 100
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3322
Practice Address - Country:US
Practice Address - Phone:574-253-1728
Practice Address - Fax:832-559-8514
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282500206Medicaid
TX883N93OtherBCBS
TXP01092354OtherRAILROAD MEDICARE
TXP01092354OtherRAILROAD MEDICARE
TXTXB161410Medicare PIN