Basic Information
Provider Information
NPI: 1851461891
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARRISON-SHORT
FirstName: KATHERINE
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HARRISON
OtherFirstName: KATHY
OtherMiddleName: JEAN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: RN,CNM
OtherLastNameType: 1
Mailing Information
Address1: 301 UNIVERSITY BLVD
Address2:  
City: GALVESTON
State: TX
PostalCode: 775555302
CountryCode: US
TelephoneNumber: 4097722222
FaxNumber:  
Practice Location
Address1: 313 E 12TH ST
Address2:  
City: AUSTIN
State: TX
PostalCode: 787011954
CountryCode: US
TelephoneNumber: 5123248670
FaxNumber: 5123248671
Other Information
ProviderEnumerationDate: 11/08/2006
LastUpdateDate: 06/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X253950TXY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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