MEDICARE: MISS KATY LAYNE BOREN MPAS, 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	PA15024	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841756236	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1740891225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATY LAYNE BOREN MPAS, PA-C

Provider Business Mailing Address
First Line	:	4707 EIGEL ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3417
Country	:	US
Telephone Number	:	713-960-1311
Fax Number	:	832-653-6407

Provider Business Practice Location Address
First Line	:	27150 HIGHWAY 290 STE 100
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-7224
Country	:	US
Telephone Number	:	832-653-3300
Fax Number	:	832-653-6407

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	07/17/2025

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