Provider Demographics
NPI:1366612194
Name:POMPA, KATHRYN JOY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JOY
Last Name:POMPA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 N. HARRISON PARKWAY
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-838-1758
Practice Address - Street 1:1500 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-920-6864
Practice Address - Fax:817-927-3958
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX079508367500000X
TX676312367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered