Provider Demographics
NPI:1386004570
Name:CHADWICK, KATHERINE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:CHADWICK
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 1:8486 COUNTY ROAD 43200
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-4335
Mailing Address - Country:US
Mailing Address - Phone:903-249-6058
Mailing Address - Fax:
Practice Address - Street 1:1122 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-0411
Practice Address - Country:US
Practice Address - Phone:903-783-1999
Practice Address - Fax:903-783-1167
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10361363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical