Provider Demographics
NPI:1598424400
Name:FUSSELL, KATHRYN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:FUSSELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:FUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:1017 RAY FISHER RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7550
Mailing Address - Country:US
Mailing Address - Phone:936-676-0772
Mailing Address - Fax:
Practice Address - Street 1:1302 TOM TEMPLE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5581
Practice Address - Country:US
Practice Address - Phone:936-634-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner