Provider Demographics
NPI: | 1932667474 |
---|---|
Name: | PENCE, CATHERINE TAYLOR (MSN, AGNP-C) |
Entity type: | Individual |
Prefix: | MS |
First Name: | CATHERINE |
Middle Name: | TAYLOR |
Last Name: | PENCE |
Suffix: | |
Gender: | F |
Credentials: | MSN, AGNP-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 150 SABINE ST APT 158 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77007-8355 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-851-1059 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12525 MEMORIAL DR STE 390 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77024-6050 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-522-7800 |
Practice Address - Fax: | 832-522-7801 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-03-04 |
Last Update Date: | 2024-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | AP140737 | 363LP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | AG02190020 | Other | THE AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD |
TX | AP140737 | Other | TEXAS BOARD OF NURSING |