Provider Demographics
NPI:1801342175
Name:GOTTLIEB, KENDRA ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ANN
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:ANN
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6500 N MOPAC EXPY
Mailing Address - Street 2:BLDG 3 STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3282
Mailing Address - Country:US
Mailing Address - Phone:512-458-8400
Mailing Address - Fax:512-458-8593
Practice Address - Street 1:6500 N MOPAC EXPY
Practice Address - Street 2:BLDG 3 STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-458-8400
Practice Address - Fax:512-458-8593
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697226163W00000X
TXAP131579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse