Individual
FREDERICK PURNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2730 SW WILSHIRE BLVD, BURLESON, TX 76028-8338
(817) 916-5180
Mailing address
2730 SW WILSHIRE BLVD, BURLESON, TX 76028-8338
(817) 916-5180
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0126001471
VA
363A00000X
Physician Assistant
0110007950
VA
363A00000X
Physician Assistant
Primary
PA15746
TX
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
09/30/2014
Last updated
07/15/2022
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