Provider Demographics
NPI:1659312262
Name:STINSON, KATHLEEN SOJOURNER (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SOJOURNER
Last Name:STINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SOJOURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 SPORTSPLEX DR
Mailing Address - Street 2:STE C
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620
Mailing Address - Country:US
Mailing Address - Phone:512-894-3737
Mailing Address - Fax:
Practice Address - Street 1:331 SPORTSPLEX DR
Practice Address - Street 2:STE C
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-894-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1800682Medicaid
TX1800682Medicaid