Provider Demographics
NPI:1114404548
Name:ESCAMILLA MEZA, AMAIRANY MADAI (PA-C)
Entity Type:Individual
Prefix:
First Name:AMAIRANY
Middle Name:MADAI
Last Name:ESCAMILLA MEZA
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 1:7817 FAIRWEST CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-7330
Mailing Address - Country:US
Mailing Address - Phone:817-770-1288
Mailing Address - Fax:
Practice Address - Street 1:410 E PIONEER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4984
Practice Address - Country:US
Practice Address - Phone:469-733-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant