Provider Demographics
NPI:1831412758
Name:ST CLAIR, KATHERINE MICHELLE (PAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-875-0413
Mailing Address - Fax:903-872-8165
Practice Address - Street 1:401 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2415
Practice Address - Country:US
Practice Address - Phone:903-875-0413
Practice Address - Fax:903-872-8165
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399031YVYXMedicare PIN