Provider Demographics
NPI:1255429569
Name:GREGORY, KATHRYN JEAN (LVN, CST, CFA, LSA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LVN, CST, CFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 MARTI LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-3257
Mailing Address - Country:US
Mailing Address - Phone:817-905-7352
Mailing Address - Fax:817-812-2900
Practice Address - Street 1:8801 MARTI LN
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-3257
Practice Address - Country:US
Practice Address - Phone:817-905-7352
Practice Address - Fax:817-812-2900
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042647164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5624377OtherCIGNA
TX094880401Medicaid
TXCD6262OtherRAILROAD MEDICARE
TX5624377OtherCIGNA