MEDICARE: MRS. COURTNEY CATHERINE CORREA PA-C

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	PA11248	TX

General Provider Information

NPI Number	:	1275051831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY CATHERINE CORREA PA-C

Provider Business Mailing Address
First Line	:	10131 W MILITARY DR STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1927
Country	:	US
Telephone Number	:	210-899-1450
Fax Number	:	210-899-1907

Provider Business Practice Location Address
First Line	:	10131 W MILITARY DR STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1927
Country	:	US
Telephone Number	:	210-899-1450
Fax Number	:	210-899-1907

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	01/03/2025

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