Provider Demographics
NPI:1952568909
Name:SWANTON, KATIE GRANGER (PA-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:GRANGER
Last Name:SWANTON
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 1:610 STRICKLAND DR STE 270
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4788
Mailing Address - Country:US
Mailing Address - Phone:409-883-5600
Mailing Address - Fax:409-883-3570
Practice Address - Street 1:205 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-2213
Practice Address - Country:US
Practice Address - Phone:409-892-7090
Practice Address - Fax:409-892-4324
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03296207R00000X, 207Y00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology