Individual
BIRUTAWIT DEREBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2323 N CENTRAL EXPY, RICHARDSON, TX 75080-2712
(214) 453-4533
Mailing address
3900 W NORTHWEST HWY APT 1211, DALLAS, TX 75220-5107
(469) 396-5297
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19185
TX
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1216882
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS (NCCPA)
—
01
—
PA19185
TEXAS MEDICAL BOARD
TX
Enumeration date
12/13/2023
Last updated
06/30/2025
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