Individual
IFRA ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
234 W CAMPBELL RD, RICHARDSON, TX 75080-3512
(972) 474-3221
Mailing address
2709 PHILLIPS DR, GARLAND, TX 75044-3731
(817) 374-0690
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15479
TX
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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