Provider Demographics
NPI:1114642170
Name:WORD, AUSTIN CHARLES (PA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CHARLES
Last Name:WORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1885 COUNTY ROAD 187D
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-1205
Mailing Address - Country:US
Mailing Address - Phone:903-808-5455
Mailing Address - Fax:
Practice Address - Street 1:1885 COUNTY ROAD 187D
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-1205
Practice Address - Country:US
Practice Address - Phone:903-808-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant