Provider Demographics
NPI:1104002997
Name:GAHAN, AMANDA GIBSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GIBSON
Last Name:GAHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:ELAINE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8109 LATIGO TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6093
Mailing Address - Country:US
Mailing Address - Phone:214-587-5418
Mailing Address - Fax:
Practice Address - Street 1:809 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3303
Practice Address - Country:US
Practice Address - Phone:972-529-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant