Healthcare Provider Details

I. General information

NPI: 1184722837
Provider Name (Legal Business Name): KATHERINE AUSTIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 DRAPER ST
KINGSBURG CA
93631-1934
US

IV. Provider business mailing address

1479 W LACEY BLVD
HANFORD CA
93230-5906
US

V. Phone/Fax

Practice location:
  • Phone: 559-897-6610
  • Fax: 559-897-6611
Mailing address:
  • Phone: 559-583-4617
  • Fax: 559-583-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: