Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 899820 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 899820 | TX |
NPI | 1356940837 |
---|---|
Provider Name | Katherine Anna Nack |
First Address | Arlington, TX 76014-2075 |
Second Address | Fort Worth, TX 76132-4127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 01/04/2021 |