Provider Demographics
NPI:1952864118
Name:DAVIDSON, KATIE M (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13103 SHOALWATER LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3465
Mailing Address - Country:US
Mailing Address - Phone:512-917-8065
Mailing Address - Fax:
Practice Address - Street 1:6620 MAIN ST STE 1450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2346
Practice Address - Country:US
Practice Address - Phone:281-558-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141204363LF0000X
TX29823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily