Provider Demographics
NPI:1922112101
Name:MAYORGA, KATHLEEN ANNE (RN CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:MAYORGA
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LOUISIANA ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4412
Mailing Address - Country:US
Mailing Address - Phone:217-428-7060
Mailing Address - Fax:972-542-8172
Practice Address - Street 1:100 E LOUISIANA ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4412
Practice Address - Country:US
Practice Address - Phone:217-428-7060
Practice Address - Fax:972-542-8172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX554960367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487837Medicaid
TX1487837Medicaid