Basic Information
Provider Information
NPI: 1306445762
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: KATHERINA
MiddleName: MARIA
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 840853
Address2:  
City: DALLAS
State: TX
PostalCode: 752840853
CountryCode: US
TelephoneNumber: 9722331999
FaxNumber: 9722333666
Practice Location
Address1: 3705 MEDICAL PKWY STE 570
Address2:  
City: AUSTIN
State: TX
PostalCode: 787051024
CountryCode: US
TelephoneNumber: 5124542554
FaxNumber: 5124542854
Other Information
ProviderEnumerationDate: 10/17/2020
LastUpdateDate: 01/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X879580TXN Nursing Service ProvidersRegistered Nurse 
367500000X1027789TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
163W00000X9490601FLN Nursing Service ProvidersRegistered Nurse 

No ID Information.


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