Provider Demographics
NPI:1083644272
Name:MANESSIER, RHONDA J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:J
Last Name:MANESSIER
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 1:5345 N GEORGE BUSH FWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2767
Mailing Address - Country:US
Mailing Address - Phone:972-495-5888
Mailing Address - Fax:972-495-0588
Practice Address - Street 1:7217 TELECOM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2203
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:469-800-2310
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00924363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332815501Medicaid
TXP72232Medicare UPIN
TX8A2745Medicare PIN
TX332815501Medicaid