Provider Demographics
NPI:1427702133
Name:SKODAK, KATHERINE NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:SKODAK
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:7008 PECAN GLEN PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4304
Mailing Address - Country:US
Mailing Address - Phone:817-807-2846
Mailing Address - Fax:
Practice Address - Street 1:900 W MAGNOLIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8518
Practice Address - Country:US
Practice Address - Phone:817-912-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2025-09-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant