Provider Demographics
NPI:1285931998
Name:SAMPSON, KATHRYN CLAY (PNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLAY
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:CLAY
Other - Last Name:SCROGGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:2400 CEDAR BEND DR
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5378
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-901-3937
Practice Address - Street 1:502 CRYSTAL FALLS PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1959
Practice Address - Country:US
Practice Address - Phone:512-260-0101
Practice Address - Fax:512-260-0121
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685442363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics