Provider Demographics
NPI:1033438502
Name:BYRA, KATHERINE M (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:BYRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13241 BARTRAM PARK BLVD
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5212
Mailing Address - Country:US
Mailing Address - Phone:904-242-4220
Mailing Address - Fax:904-551-1502
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:SUITE # 209
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5212
Practice Address - Country:US
Practice Address - Phone:904-242-4220
Practice Address - Fax:904-551-1502
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116486208000000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010556400Medicaid