Provider Demographics
NPI:1619691953
Name:SUMMERLIN, KATHERINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 SOUTH FWY STE 365
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7045
Mailing Address - Country:US
Mailing Address - Phone:817-551-5539
Mailing Address - Fax:817-568-6805
Practice Address - Street 1:1759 BROAD PARK CIR S STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7834
Practice Address - Country:US
Practice Address - Phone:682-341-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily