Provider Demographics
NPI:1710297155
Name:KEHOE, KARA LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LEIGH
Last Name:KEHOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LEIGH
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 REGENCY PKWY STE 405
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5169
Mailing Address - Country:US
Mailing Address - Phone:682-518-1100
Mailing Address - Fax:682-518-1104
Practice Address - Street 1:305 REGENCY PKWY STE 405
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5169
Practice Address - Country:US
Practice Address - Phone:682-518-1100
Practice Address - Fax:682-518-1104
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTEMPORARY LICENSEOtherTEXAS MEDICAL BOARD
TXPA06926OtherTEXAS MEDICAL BOARD