Provider Demographics
NPI:1013253988
Name:BOX, KATHLEEN JO (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JO
Last Name:BOX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JO
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:DEPT. OF ANESTHESIOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-590-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX749415367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01445704OtherRAILROAD
TX8795UGOtherBCBD
TN321920603Medicaid
TXP01445704OtherRAILROAD