Provider Demographics
NPI:1205967197
Name:GWINN, KATRINA A (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:A
Last Name:GWINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:A
Other - Last Name:GWINN-HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 BAYLOR PLZ
Mailing Address - Street 2:T-903 MHG
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-798-5703
Mailing Address - Fax:713-798-8597
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:T-903 MHG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-5703
Practice Address - Fax:713-798-8597
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00575222084N0400X
TXN25412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L16923Medicare PIN
MDG06178Medicare UPIN