Provider Demographics
NPI:1033846654
Name:TBABA, KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TBABA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE STE 366
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1592
Mailing Address - Country:US
Mailing Address - Phone:214-941-2777
Mailing Address - Fax:214-941-2929
Practice Address - Street 1:1411 N BECKLEY AVE STE 366
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1592
Practice Address - Country:US
Practice Address - Phone:214-941-2777
Practice Address - Fax:214-941-2929
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX870666163W00000X
TX1027765363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse