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General NPI Number Information
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NPI Number | 1487079661
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Entity Type | Individual
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Provider Name | KATINA FOWLER HUTSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 9101 N CENTRAL EXPY STE 600
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City | DALLAS
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State | TX
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Zip | 75231-5956
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Country | US
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Telephone | 214-818-0935
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Fax | 214-887-3525
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Provider Business Mailing Address
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Address Line | 1342 BUENA PARK DR
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City | FRISCO
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State | TX
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Zip | 75033-1498
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Country | US
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Telephone | 601-624-8002
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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 | PA09005
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License Number State | TX
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