Provider Demographics
NPI:1306543939
Name:SINGH, KATELYNN MICHELLE
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MICHELLE
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-2192
Mailing Address - Country:US
Mailing Address - Phone:254-495-1521
Mailing Address - Fax:
Practice Address - Street 1:763 E US HIGHWAY 80 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8675
Practice Address - Country:US
Practice Address - Phone:972-564-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant