Provider Demographics
NPI:1750632626
Name:MARTIN, KATIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 PECAN CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6891
Mailing Address - Country:US
Mailing Address - Phone:281-468-7773
Mailing Address - Fax:
Practice Address - Street 1:602 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8328
Practice Address - Country:US
Practice Address - Phone:281-392-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily