Provider Demographics
NPI:1538304803
Name:LORD, KATHARINE FISKE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:FISKE
Last Name:LORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
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 1:901 W 38TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-421-4100
Practice Address - Fax:512-454-4575
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07880363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310007502Medicaid
TXP01808897OtherRAILROAD
TX310007501Medicaid