Provider Demographics
NPI:1801846456
Name:CODY, KATHARINE A (RN, ND, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:A
Last Name:CODY
Suffix:
Gender:F
Credentials:RN, ND, FNP-C
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3718
Mailing Address - Country:US
Mailing Address - Phone:379-919-2763
Mailing Address - Fax:337-943-0846
Practice Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7203
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704317363LA2200X
TXAP113141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165849401Medicaid
TX165849401Medicaid
TX8B6815Medicare ID - Type UnspecifiedMEDICARE