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NPI Code Detail

MEDICARE: KATRINA IRIS BANSIGAN

MEDICARE: KATRINA IRIS BANSIGAN
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
1363A00000XPhysician AssistantPA18373TX
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1376262691
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRINA IRIS BANSIGAN
Provider Business Mailing Address
First Line : 213 BAYFIELD DR
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8606
Country : US
Telephone Number : 469-450-5653
Fax Number :
Provider Business Practice Location Address
First Line : 1915 E MAYFIELD RD STE 115
Second Line :
City : ARLINGTON
State : TX
Zip : 76014-2605
Country : US
Telephone Number : 682-276-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2022
Last Update Date : 10/15/2024

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Directions to “ KATRINA IRIS BANSIGAN ” Practice Location

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