Provider Demographics
NPI:1619554664
Name:STEPHENS, CATHERINE M
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 CONVAIR DR
Mailing Address - Street 2:STE 509
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1276
Mailing Address - Country:US
Mailing Address - Phone:817-349-7541
Mailing Address - Fax:817-349-7549
Practice Address - Street 1:5925 CONVAIR DR STE 509
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1276
Practice Address - Country:US
Practice Address - Phone:817-349-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF03210688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily