Individual
TRICIA NICOLE MEWBOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4708 ALLIANCE BLVD, SUITE 810, PLANO, TX 75093-5340
(972) 985-2797
(972) 985-4797
Mailing address
8080 INDEPENDENCE PKWY, STE 230, PLANO, TX 75025-4013
(972) 985-2797
(972) 985-4797
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
07016
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009939411
—
AL
01
—
51004134
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/08/2006
Last updated
06/25/2018
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