Provider Demographics
NPI:1093188831
Name:DVORSKY, KATELYN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DVORSKY
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 1:6101 WOODWAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6111
Mailing Address - Country:US
Mailing Address - Phone:254-537-6300
Mailing Address - Fax:254-537-6301
Practice Address - Street 1:6101 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6111
Practice Address - Country:US
Practice Address - Phone:254-537-6300
Practice Address - Fax:254-537-6301
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10191363A00000X
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant