Basic Information
| Provider Information | |||||||||
| NPI: | 1093852048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMERITT | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 DOLTON DR | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776578160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092274053 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3080 COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092125000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 09/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 10000552 | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.