Provider Demographics
NPI:1508896465
Name:OWEN, KATHERINE ELIZABETH (PA C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:OWEN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5503 N STATE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5303
Mailing Address - Country:US
Mailing Address - Phone:903-794-7874
Mailing Address - Fax:903-794-0741
Practice Address - Street 1:5503 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5303
Practice Address - Country:US
Practice Address - Phone:903-794-7874
Practice Address - Fax:903-794-0741
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant