Provider Demographics
NPI:1386092245
Name:HOTH, MARY KATHERINE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:HOTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 FM 546
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1272
Mailing Address - Country:US
Mailing Address - Phone:715-797-0867
Mailing Address - Fax:
Practice Address - Street 1:7808 CLODUS FIELDS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2206
Practice Address - Country:US
Practice Address - Phone:972-991-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78281-0164W00000X
TX921167163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse