Provider Demographics
NPI:1104961481
Name:WHITFIELD, KATHERINE A (CPNP PC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:CPNP PC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 120549
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-303-4521
Mailing Address - Fax:817-459-2856
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:#550
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-784-0818
Practice Address - Fax:817-335-0938
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5936Medicare PIN