Provider Demographics
NPI:1013569284
Name:BERGER, KATHARYN ELIZABETH JOY (PA)
Entity Type:Individual
Prefix:MS
First Name:KATHARYN
Middle Name:ELIZABETH JOY
Last Name:BERGER
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 1:1290 WONDER WORLD DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7969
Mailing Address - Country:US
Mailing Address - Phone:512-393-3325
Mailing Address - Fax:512-393-3328
Practice Address - Street 1:1290 WONDER WORLD DR STE 1100
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7969
Practice Address - Country:US
Practice Address - Phone:512-393-3325
Practice Address - Fax:512-393-3328
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant