Provider Demographics
NPI:1144239120
Name:KNOWLES, KENDRA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MICHELLE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:MICHELLE
Other - Last Name:BRASELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1125 RAINTREE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5289
Mailing Address - Country:US
Mailing Address - Phone:972-727-9995
Mailing Address - Fax:972-727-8350
Practice Address - Street 1:1125 RAINTREE CIR STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5289
Practice Address - Country:US
Practice Address - Phone:972-727-9995
Practice Address - Fax:972-727-8350
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A5584OtherBCBS
TXP00123345Medicare PIN
TX8A5584OtherBCBS
P85591Medicare UPIN
TX8A5584Medicare PIN
TXP00004409Medicare PIN
TXTXB111683Medicare PIN