MEDICARE: KATLYN BARBOUR

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	363A00000X	Physician Assistant	PA18761	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114755659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATLYN BARBOUR

Provider Business Mailing Address
First Line	:	1627 PINE RIDGE PL
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5708
Country	:	US
Telephone Number	:	601-213-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 N MACARTHUR BLVD STE 700
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2204
Country	:	US
Telephone Number	:	469-800-1300
Fax Number	:

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	06/01/2026

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Directions to “ KATLYN BARBOUR ” Practice Location

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