Provider Demographics
NPI:1245915222
Name:PATTAT, BETHANY (CSA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:PATTAT
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-6802
Mailing Address - Country:US
Mailing Address - Phone:903-312-0090
Mailing Address - Fax:
Practice Address - Street 1:4000 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-6802
Practice Address - Country:US
Practice Address - Phone:903-312-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5056208600000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery