Provider Demographics
NPI:1205393196
Name:THIMESCH, AMY EVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:EVAN
Last Name:THIMESCH
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 1:4325 N JOSEY LN STE 105
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4636
Mailing Address - Country:US
Mailing Address - Phone:972-394-9478
Mailing Address - Fax:972-394-7656
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-394-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine