Provider Demographics
NPI:1932878832
Name:WILDER, KATHARINA INGEBORG LEONORE (APRN-C)
Entity Type:Individual
Prefix:
First Name:KATHARINA
Middle Name:INGEBORG LEONORE
Last Name:WILDER
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:KATHARINA
Other - Middle Name:INGEBORG LEONORE
Other - Last Name:BREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:3507 N LAMAR BLVD UNIT 301341
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:844 KOHLERS XING STE 230
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2475
Practice Address - Country:US
Practice Address - Phone:737-404-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX924946163WC0200X
TX1128385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine