Provider Demographics
NPI:1912975376
Name:HARVEY, KATHRYN MARY (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARY
Last Name:HARVEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:PIETRUSIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4433 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3610
Mailing Address - Country:US
Mailing Address - Phone:214-205-5887
Mailing Address - Fax:
Practice Address - Street 1:11550 LEGACY DR STE 420
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033
Practice Address - Country:US
Practice Address - Phone:214-205-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179633363L00000X
TXAP132479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00361952OtherRR MCR
P00361952OtherRR MCR
FLQ75044Medicare UPIN