Provider Demographics
NPI:1356427934
Name:MINOR, KATHRYN A (PAC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:MINOR
Suffix:
Gender:F
Credentials:PAC
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:7777 FOREST LN STE D400
Practice Address - Street 2:SUITE 301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6899
Practice Address - Country:US
Practice Address - Phone:972-566-7790
Practice Address - Fax:972-566-5819
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12217363AS0400X
TXPA06362363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01932457OtherRAILROAD
TX345574302Medicaid
TX345574303Medicaid
CAPA12217Medicaid