Provider Demographics
NPI:1003062639
Name:ERWIN, KATHLEEN (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 S DENTON TAP RD STE 250
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4565
Mailing Address - Country:US
Mailing Address - Phone:972-745-6590
Mailing Address - Fax:972-745-6595
Practice Address - Street 1:878 S DENTON TAP RD STE 250
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4565
Practice Address - Country:US
Practice Address - Phone:972-745-6590
Practice Address - Fax:972-745-6595
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196782004Medicaid
TX196782001Medicaid
TX196782003Medicaid
TX196782002Medicaid
TX8L9590Medicare PIN
TX8L9585Medicare PIN
TX8L2122Medicare PIN
TX8L9584Medicare PIN
TX8L2120Medicare PIN
TX196782003Medicaid
TX8L2121Medicare PIN