MEDICARE: KATERINA LY PA-C

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	363AS0400X	Surgical Physician Assistant		TX

General Provider Information

NPI Number	:	1629958749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERINA LY PA-C

Provider Business Mailing Address
First Line	:	4925 GREENVILLE AVE
Second Line	:	STE 1307, ENERGY SQUARE 1
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	214-242-1389
Fax Number	:	214-351-8451

Provider Business Practice Location Address
First Line	:	4925 GREENVILLE AVE
Second Line	:	STE 1307, ENERGY SQUARE 1
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	214-242-1389
Fax Number	:	214-351-8451

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

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	12/09/2025

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Directions to “ KATERINA LY PA-C” Practice Location

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