Provider Demographics
NPI:1518026855
Name:STAUFFER, KATHLEEN GEORGETTE (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GEORGETTE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:STAUFFER
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:254-286-7327
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-772-2222
Practice Address - Fax:254-286-7327
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518698367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K4347Medicare PIN