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General NPI Number Information
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NPI Number | 1629958749
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Entity Type | Individual
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Provider Name | KATERINA LY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 4925 GREENVILLE AVE STE 1307, ENERGY SQUARE 1
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City | DALLAS
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State | TX
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Zip | 75206
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Country | US
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Telephone | 214-242-1389
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Fax | 214-351-8451
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Provider Business Mailing Address
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Address Line | 4925 GREENVILLE AVE STE 1307, ENERGY SQUARE 1
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City | DALLAS
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State | TX
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Zip | 75206
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Country | US
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Telephone | 214-242-1389
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Fax | 214-351-8451
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | TX
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