Provider Demographics
NPI:1073745428
Name:ATWELL, CINDY L (PA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:ATWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4467
Mailing Address - Country:US
Mailing Address - Phone:817-900-8031
Mailing Address - Fax:817-367-2417
Practice Address - Street 1:9668 BARTLETT CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4467
Practice Address - Country:US
Practice Address - Phone:817-900-8031
Practice Address - Fax:817-367-2417
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB150409OtherPTAN
TXTXB125234Medicare PIN
TXTXB125233Medicare PIN
TXTXB150409OtherPTAN
TXTXB125235Medicare PIN
TX8L17997Medicare PIN
TX8L17995Medicare PIN