Provider Demographics
NPI:1710450226
Name:CORTES, JULIE KATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHRYN
Last Name:CORTES
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 1:2251 COUNTRY CLUB DR STE 131
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4765
Mailing Address - Country:US
Mailing Address - Phone:682-518-1100
Mailing Address - Fax:682-518-1104
Practice Address - Street 1:2251 COUNTRY CLUB DRIVE
Practice Address - Street 2:STE 131
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:682-518-1100
Practice Address - Fax:682-518-1104
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TX363A00000X
TXPA12613363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710450226Medicaid