Provider Demographics
NPI:1255066635
Name:HENRY, KATHERINE MARGARET THERESA (APRN, FNP-C)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MARGARET THERESA
Last Name:HENRY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2010 E STATE HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6514
Mailing Address - Country:US
Mailing Address - Phone:817-893-9200
Mailing Address - Fax:817-893-9300
Practice Address - Street 1:2010 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6514
Practice Address - Country:US
Practice Address - Phone:817-893-9200
Practice Address - Fax:817-893-9300
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067008363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily