Basic Information
| Provider Information | |||||||||
| NPI: | 1699220707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ANNE WILLIAMS | ||||||||
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| Credential: | FNP | ||||||||
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| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3751 MAIN ST | ||||||||
| Address2: | SUITE 600 #194 | ||||||||
| City: | THE COLONY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750562808 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 947 SCOTLAND DR | ||||||||
| Address2: | SUITE #107 | ||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727093415 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2016 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP131223 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.