Provider Demographics
NPI:1093966178
Name:GOOD, KATIE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MARIE
Last Name:GOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:HABERSBRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:4101 JAMES CASEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3325
Practice Address - Country:US
Practice Address - Phone:512-447-2202
Practice Address - Fax:512-447-5337
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003833363A00000X
TX553281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01867705OtherRAILROAD
TX324876701Medicaid
WI1093966178Medicaid
TX324876702Medicaid
WI462100044Medicare PIN
TX317574YKYCMedicare PIN
WI1093966178Medicaid
TX324876701Medicaid