Basic Information
| Provider Information | |||||||||
| NPI: | 1942830211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNKLE | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1809 N CARLSBAD LN | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775366080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812991791 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775874252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139467461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2020 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 1015314 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 1015314 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 20038551 | 05 | TX | MEDICAID |