Provider Demographics
NPI:1467189837
Name:CATHCART, KELSEY ANN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:CATHCART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10306 GOLDEN QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5621
Mailing Address - Country:US
Mailing Address - Phone:316-641-0080
Mailing Address - Fax:
Practice Address - Street 1:4303 JAMES CASEY ST STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1188
Practice Address - Country:US
Practice Address - Phone:512-444-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX856490163W00000X
TX1088290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse