Katrina Jean Tidwell PA-C

NPI 1790912806 - Physician Assistant - 363A00000X

NPI Details
NPI 1790912806
Gender Female
Enumeration Date 06/16/2009
Last Updated 08/28/2015
Entity Type Individual
Active Over 7 years ago
Practice Location
8196 WALNUT HILL LN
STE 100
DALLAS TX, 75231-4452, US
Phone (214) 739-4175
Fax (214) 346-3516
Business Location
8196 WALNUT HILL LN
STE 100
DALLAS TX, 75231-4452, US
Phone (214) 739-4175
Fax (972) 234-2987
Toxanomy
Taxonomy Code 363A00000X
License State Texas
License Number PA03458
Remove 1790912806 NPI Number
 

According to our database, Katrina Jean Tidwell PA-C NPI is 1790912806, taxonomy code is 363A00000X and license number is PA03458, license state is located at Texas. Katrina Jean Tidwell PA-C physically located at 8196 Walnut Hill Ln, Dallas TX, 75231-4452. NPI Number Katrina Jean Tidwell PA-C has the Individual type.

Sponsored links

1790912806 NPI number is provided on an as is basis without warranty of any kind. 1790912806 is maintained by the National Plan & Provider Enumeration System. The contents of Katrina Jean Tidwell PA-C are for informational purposes only.