Provider Demographics
NPI:1891273710
Name:REGAN, KATHERINE BUTLER (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BUTLER
Last Name:REGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE-MARY
Other - Middle Name:HOSEMANN
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1142 ELEANOR ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2116
Mailing Address - Country:US
Mailing Address - Phone:214-417-3668
Mailing Address - Fax:
Practice Address - Street 1:901 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6903
Practice Address - Country:US
Practice Address - Phone:512-816-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily