Provider Demographics
NPI:1851620116
Name:MARTIN, KATHRYN ASHLEY (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ASHLEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:512-421-4250
Mailing Address - Fax:972-997-8000
Practice Address - Street 1:1015 E 32ND ST STE 306
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2701
Practice Address - Country:US
Practice Address - Phone:512-294-2180
Practice Address - Fax:512-822-7640
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711961363L00000X
TXAP118245363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216102803Medicaid
TX216102801Medicaid