Provider Demographics
NPI:1619983301
Name:GRIFFIN, KATHLEEN ALEXIS (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALEXIS
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10606 ELMDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3336
Mailing Address - Country:US
Mailing Address - Phone:281-732-4345
Mailing Address - Fax:
Practice Address - Street 1:11411 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3610
Practice Address - Country:US
Practice Address - Phone:281-890-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX437928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64532Medicare UPIN