MEDICARE: KAREN S KOTARA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03588	TX

General Provider Information

NPI Number	:	1073606810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN S KOTARA PA

Provider Business Mailing Address
First Line	:	PO BOX 761
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-0761
Country	:	US
Telephone Number	:	817-565-8904
Fax Number	:	877-515-5209

Provider Business Practice Location Address
First Line	:	6100 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3703
Country	:	US
Telephone Number	:	817-237-3321
Fax Number	:	817-237-7970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/11/2019

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Directions to “ KAREN S KOTARA PA” Practice Location

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