Healthcare Provider Details

I. General information

NPI: 1134504202
Provider Name (Legal Business Name): ARPY JITENDRA KOTHARI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 WILLIAMS DR
GEORGETOWN TX
78633-1302
US

IV. Provider business mailing address

4513 WILLIAMS DR
GEORGETOWN TX
78633-1302
US

V. Phone/Fax

Practice location:
  • Phone: 512-930-3909
  • Fax: 512-869-5868
Mailing address:
  • Phone: 512-930-3909
  • Fax: 214-736-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: