Provider Demographics
NPI:1801990205
Name:VANDEGIESSEN, KATHLEEN (CNM MSN MBA)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:VANDEGIESSEN
Suffix:
Gender:F
Credentials:CNM MSN MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 NORTH FWY
Mailing Address - Street 2:SUITE 435
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1324
Mailing Address - Country:US
Mailing Address - Phone:713-699-4211
Mailing Address - Fax:713-699-8996
Practice Address - Street 1:7007 NORTH FWY
Practice Address - Street 2:SUITE 435
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1324
Practice Address - Country:US
Practice Address - Phone:713-699-4211
Practice Address - Fax:713-699-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438110176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801990205OtherNPI
TX090025002Medicaid
TX090025002Medicaid
TX1801990205OtherNPI