Provider Demographics
NPI:1699220707
Name:JOHNSON, KATHERINE ANNE WILLIAMS (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE WILLIAMS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3751 MAIN ST
Mailing Address - Street 2:SUITE 600 #194
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:947 SCOTLAND DR
Practice Address - Street 2:SUITE #107
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2090
Practice Address - Country:US
Practice Address - Phone:972-709-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily