MEDICARE: CATHERINE ELIZABETH HEIDER 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	363A00000X	Physician Assistant	PA12102	TX

General Provider Information

NPI Number	:	1871084269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ELIZABETH HEIDER PA-C

Provider Business Mailing Address
First Line	:	4323 DICKASON AVE APT 17
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2636
Country	:	US
Telephone Number	:	817-734-7102
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 BRENTWOOD STAIR RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112
Country	:	US
Telephone Number	:	817-451-4208
Fax Number	:

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

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	03/23/2026

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