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General NPI Number Information
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NPI Number | 1033432349
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Entity Type | Individual
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Provider Name | MARY KOETTING PA
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 726 S. COCKRELL RD.
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City | DUNCANVILLE
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State | TX
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Zip | 75137
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Country | US
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Telephone | 972-780-0802
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Fax |
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Provider Business Mailing Address
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Address Line | 600 WESTER RD
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City | FERRIS
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State | TX
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Zip | 75125-9711
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Country | US
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Telephone | 214-213-4707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01749
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License Number State | TX
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