Provider Demographics
NPI:1063497527
Name:LAYDEN, JOAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:LAYDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975341
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8440 WALNUT HILL LN STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3824
Practice Address - Country:US
Practice Address - Phone:214-345-5999
Practice Address - Fax:214-345-5988
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180892501Medicaid
TX82N843OtherBLUE CROSS BLUE SHIELD
TXP00049542OtherRAILROAD MEDICARE
TXTXB113782Medicare PIN
TX82N843OtherBLUE CROSS BLUE SHIELD
TX348274YKQLMedicare PIN