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General NPI Number Information
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NPI Number | 1578120994
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Entity Type | Individual
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Provider Name | KATHERINE ANN MINYARD PA-C, ATC, EMT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 915 N FRANKLIN ST UNIT 1122
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City | TAMPA
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State | FL
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Zip | 33602-3869
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Country | US
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Telephone | 619-929-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 915 N FRANKLIN ST UNIT 1122
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City | TAMPA
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State | FL
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Zip | 33602-3869
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000035201
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14226777-1206
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License Number State | UT
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