Provider Demographics
NPI:1073587705
Name:MOHNICKEY, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MOHNICKEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 DALLAS PKWY
Mailing Address - Street 2:STE 640
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8719
Mailing Address - Country:US
Mailing Address - Phone:469-277-8255
Mailing Address - Fax:866-509-8481
Practice Address - Street 1:3014 N O CONNOR RD
Practice Address - Street 2:STE 110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4415
Practice Address - Country:US
Practice Address - Phone:469-277-8255
Practice Address - Fax:866-509-8481
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0000670363AS0400X
TXPA03349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513051Medicaid
TX212093301Medicaid
TX212093303Medicaid
TX212093302Medicaid
TX212093302Medicaid
OHPA11297Medicare ID - Type Unspecified
TXTXB100607Medicare PIN
S76600Medicare UPIN
TXTXB100603Medicare PIN