Provider Demographics
NPI:1023762812
Name:GRANADOS, KATHRYN MARGARET (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARGARET
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 TIOGA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3118
Mailing Address - Country:US
Mailing Address - Phone:210-495-4888
Mailing Address - Fax:
Practice Address - Street 1:9518 TIOGA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3118
Practice Address - Country:US
Practice Address - Phone:210-495-4888
Practice Address - Fax:210-495-1333
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health