Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 660544 | TX |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP115846 | TX |
NPI | 1003019969 |
---|---|
Provider Name | Amy Katherine Haverty |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 11/08/2020 |