Provider Demographics
NPI:1134634074
Name:CONRAD, KATHARINE R (PA)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:R
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KATHARINE
Other - Middle Name:R
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1628
Practice Address - Country:US
Practice Address - Phone:512-371-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
TXPA16647363A00000X
AZ6764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant