Provider Demographics
NPI:1871084269
Name:HEIDER, CATHERINE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:HEIDER
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 1:9030 SOUTHWESTERN BLVD APT 3202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1541
Mailing Address - Country:US
Mailing Address - Phone:817-734-7102
Mailing Address - Fax:
Practice Address - Street 1:6451 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:817-451-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant