Provider Demographics
NPI:1356460463
Name:MARSHALL, KATHY J (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:MARSHALL
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 1:709 HIDDEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-6091
Mailing Address - Country:US
Mailing Address - Phone:281-770-4916
Mailing Address - Fax:
Practice Address - Street 1:255 FM 51B
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565
Practice Address - Country:US
Practice Address - Phone:281-535-2439
Practice Address - Fax:281-535-2823
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical