Provider Demographics
NPI:1548398928
Name:MENAGER, KATHERINE FAYE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:FAYE
Last Name:MENAGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1406 E HOUSTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5346
Mailing Address - Country:US
Mailing Address - Phone:361-542-8186
Mailing Address - Fax:361-881-4291
Practice Address - Street 1:1406 E HOUSTON ST STE B
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5346
Practice Address - Country:US
Practice Address - Phone:361-542-8186
Practice Address - Fax:361-881-4291
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571066363LF0000X
TXAP114056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12349Medicare PIN