Provider Demographics
NPI:1174883938
Name:RODRIGUEZ, KATY (PA-C)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:NAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2801 GATEWAY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2694
Mailing Address - Country:US
Mailing Address - Phone:844-388-6541
Mailing Address - Fax:844-452-8151
Practice Address - Street 1:2801 GATEWAY DR
Practice Address - Street 2:STE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2694
Practice Address - Country:US
Practice Address - Phone:844-388-6541
Practice Address - Fax:844-452-8151
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303494401Medicaid
TXTXB158855Medicare PIN
TX303494401Medicaid