Provider Demographics
NPI:1366434920
Name:VONACHEN, KATHRYN M (CRNA)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:VONACHEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:979-691-3300
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-1811
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117818367500000X
MO142449367500000X
IL041-322526367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO911636900Medicaid
P00337762Medicare PIN
MO911636900Medicaid
ILQ29973Medicare UPIN
MO83131355Medicare PIN