Provider Demographics
NPI:1245947431
Name:PURVIS, KATIE JEAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:PURVIS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9130
Mailing Address - Country:US
Mailing Address - Phone:469-502-5321
Mailing Address - Fax:
Practice Address - Street 1:3900 ARLINGTON HIGHLANDS BLVD STE 237
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6040
Practice Address - Country:US
Practice Address - Phone:469-747-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX877537163WP0807X
TX1097920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent