Provider Demographics
NPI:1184809493
Name:BUFORD, KATIE L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:L
Last Name:BUFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6444
Mailing Address - Country:US
Mailing Address - Phone:214-394-0029
Mailing Address - Fax:214-853-4644
Practice Address - Street 1:1015 N CARROLL AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6607
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX279632YMZXMedicare PIN