Provider Demographics
NPI:1366778185
Name:CROW, KATHERINE S (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:CROW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:S
Other - Last Name:MAXEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-5777
Mailing Address - Fax:
Practice Address - Street 1:7979 WURZBACH RD STE U219
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-567-5777
Practice Address - Fax:210-702-4233
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200314363A00000X
TXPA09901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310867205Medicaid
TX310867206OtherCSHCN
TX310867206OtherCSHCN