Provider Demographics
NPI:1093243115
Name:KALVAITIS, ASHLEY M (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:KALVAITIS
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 1:1202 E ARAPAHO RD STE 122
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2400
Mailing Address - Country:US
Mailing Address - Phone:469-250-4422
Mailing Address - Fax:469-250-7068
Practice Address - Street 1:1202 E ARAPAHO RD STE 122
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2400
Practice Address - Country:US
Practice Address - Phone:469-250-4422
Practice Address - Fax:469-250-7068
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant