Provider Demographics
NPI:1639500465
Name:SHIRLEY, KATHRYN RUTH (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RUTH
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RUTH
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 SCENIC DR STE G002
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7726
Mailing Address - Country:US
Mailing Address - Phone:512-531-5200
Mailing Address - Fax:512-865-4068
Practice Address - Street 1:2000 SCENIC DR STE G002
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7726
Practice Address - Country:US
Practice Address - Phone:512-531-5200
Practice Address - Fax:512-865-4068
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX530719363L00000X
TXAP124445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332504501Medicaid
TX332504502Medicaid
TX341630YN57Medicare PIN
TX332504502Medicaid