Provider Demographics
NPI:1174212427
Name:CAULFIELD, KATY BLY (AGPCNP)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:BLY
Last Name:CAULFIELD
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7947 COLONIAL WOODS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5001
Mailing Address - Country:US
Mailing Address - Phone:210-414-0982
Mailing Address - Fax:
Practice Address - Street 1:9618 HUEBNER RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1776
Practice Address - Country:US
Practice Address - Phone:210-651-0303
Practice Address - Fax:210-651-0302
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115957363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology