Provider Demographics
NPI:1578895629
Name:FREY, KATELIN M (PA)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:M
Last Name:FREY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6405
Mailing Address - Country:US
Mailing Address - Phone:512-600-2888
Mailing Address - Fax:
Practice Address - Street 1:1600 W 38TH ST STE 206
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6405
Practice Address - Country:US
Practice Address - Phone:512-600-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant