Provider Demographics
NPI:1447629290
Name:DAVIS, KATHRYN NOEL (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NOEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2126
Mailing Address - Country:US
Mailing Address - Phone:972-824-1652
Mailing Address - Fax:
Practice Address - Street 1:7300 ELDORADO PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7891
Practice Address - Country:US
Practice Address - Phone:972-747-0440
Practice Address - Fax:972-747-0441
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10086363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical