Provider Demographics
NPI:1720617319
Name:BASTIE, KATHERINE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:BASTIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:NICOLE
Other - Last Name:KONSTANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 PINECROFT DR STE 465
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3285
Mailing Address - Country:US
Mailing Address - Phone:832-562-2009
Mailing Address - Fax:832-562-2007
Practice Address - Street 1:9200 PINECROFT DR STE 465
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3285
Practice Address - Country:US
Practice Address - Phone:832-562-2009
Practice Address - Fax:832-562-2007
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8761390200000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program