Provider Demographics
NPI:1851972632
Name:GUTIERREZ, KATHRYN ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CURIE DR STE 5000
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2988
Mailing Address - Country:US
Mailing Address - Phone:915-545-1252
Mailing Address - Fax:915-545-1278
Practice Address - Street 1:1700 CURIE DR STE 5000
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2988
Practice Address - Country:US
Practice Address - Phone:915-545-1252
Practice Address - Fax:915-545-1278
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX795501163W00000X
TXF02210173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02210173OtherFAMILY NURSE PRACTITIONER CERTIFICATION
TX795501OtherREGISTERED NURSE LICENSE NUMBER