Provider Demographics
NPI:1144533464
Name:KRUEGER, KATIE MAY (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MAY
Last Name:KRUEGER
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 1:18152 PRESTON RD STE I-2
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5427
Mailing Address - Country:US
Mailing Address - Phone:469-200-2832
Mailing Address - Fax:469-269-1074
Practice Address - Street 1:18152 PRESTON RD STE I-2
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5427
Practice Address - Country:US
Practice Address - Phone:469-200-2832
Practice Address - Fax:469-269-1074
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06766363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00871043OtherRAILROAD MEDICARE
TXTXB110615Medicare PIN