Basic Information
| Provider Information | |||||||||
| NPI: | 1689154882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLVILLE | ||||||||
| FirstName: | KATHIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 FAIRWAY DR | ||||||||
| Address2: | |||||||||
| City: | CANYON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790151810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066839965 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 MEDI PARK DR STE 2048 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791062109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063532101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 755437 | TX | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.