Provider Demographics
NPI:1982231692
Name:GOMEZ, KATHERINIE NICHOLE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINIE
Middle Name:NICHOLE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 COUNTY ROAD 373
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-1264
Mailing Address - Country:US
Mailing Address - Phone:830-591-6283
Mailing Address - Fax:
Practice Address - Street 1:1059 COUNTY ROAD 373
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-1264
Practice Address - Country:US
Practice Address - Phone:830-591-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316032164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse