Provider Demographics
NPI:1982204731
Name:CALARA, KATHLEEN MARIE VELASQUEZ (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN MARIE
Middle Name:VELASQUEZ
Last Name:CALARA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 YORK BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4417
Mailing Address - Country:US
Mailing Address - Phone:210-787-6377
Mailing Address - Fax:
Practice Address - Street 1:6570 INGRAM RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3900
Practice Address - Country:US
Practice Address - Phone:210-520-5588
Practice Address - Fax:210-522-1125
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145959363LF0000X
TX831425163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse