Provider Demographics
NPI:1114600327
Name:MCWHORTER, NICOLE ELISE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELISE
Last Name:MCWHORTER
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 1:950 E BELT LINE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2424
Mailing Address - Country:US
Mailing Address - Phone:972-291-7863
Mailing Address - Fax:972-291-0942
Practice Address - Street 1:950 E BELT LINE RD STE 150
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2424
Practice Address - Country:US
Practice Address - Phone:972-291-7863
Practice Address - Fax:972-291-0942
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant