Provider Demographics
NPI:1760259758
Name:NANTZ, KATHERYN ROSE
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ROSE
Last Name:NANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 LOUIS HENNA BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7074
Mailing Address - Country:US
Mailing Address - Phone:737-241-2994
Mailing Address - Fax:
Practice Address - Street 1:799 LOUIS HENNA BLVD # 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7074
Practice Address - Country:US
Practice Address - Phone:737-241-2994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program