Provider Demographics
NPI:1184863714
Name:CARDINAL, DUSTEN (PA-C)
Entity Type:Individual
Prefix:
First Name:DUSTEN
Middle Name:
Last Name:CARDINAL
Suffix:
Gender:M
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 1:300 W KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3438
Mailing Address - Country:US
Mailing Address - Phone:972-882-7120
Mailing Address - Fax:
Practice Address - Street 1:300 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3438
Practice Address - Country:US
Practice Address - Phone:972-882-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant