MEDICARE: KATHERINE TBABA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	870666	TX
2	363LP0200X	Pediatric Nurse Practitioner	1027765	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1027765	TX

General Provider Information

NPI Number	:	1033846654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE TBABA NP

Provider Business Mailing Address
First Line	:	1411 N BECKLEY AVE STE 366
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1592
Country	:	US
Telephone Number	:	214-941-2777
Fax Number	:	214-941-2929

Provider Business Practice Location Address
First Line	:	1411 N BECKLEY AVE STE 366
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1592
Country	:	US
Telephone Number	:	214-941-2777
Fax Number	:	214-941-2929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	01/12/2026

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Directions to “ KATHERINE TBABA NP” Practice Location

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