Provider Demographics
NPI:1760599377
Name:BORTHS, KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BORTHS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BECKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17183 INTERSTATE 45 S STE 330
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3313
Mailing Address - Country:US
Mailing Address - Phone:936-270-3655
Mailing Address - Fax:936-270-3656
Practice Address - Street 1:17183 INTERSTATE 45 S STE 330
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3313
Practice Address - Country:US
Practice Address - Phone:936-270-3655
Practice Address - Fax:936-270-3656
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180726502Medicaid
TXP00391304OtherRR MEDICARE
TX8N8700OtherBLUE CROSS BLUE SHIELD
TX8315NVOtherBCBS
TX180726503Medicaid
TX180726501Medicaid
TX8FU755OtherBCBS
TX180726502Medicaid
TXQ51111Medicare UPIN
TX543734ZSWDMedicare PIN
TX8FU755OtherBCBS
TX543734ZSVEMedicare PIN
TX483574YMVQMedicare PIN