Provider Demographics
NPI:1053876151
Name:IVES, KATHRYN VELIN (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:VELIN
Last Name:IVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:VELIN
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4001 ROSS AVE APT 223
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5206
Mailing Address - Country:US
Mailing Address - Phone:214-280-6704
Mailing Address - Fax:
Practice Address - Street 1:7217 TELECOM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2203
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant