Provider Demographics
NPI:1295857902
Name:WELBORN, PATRICIA A (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WELBORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5701 W KIEST BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-1047
Mailing Address - Country:US
Mailing Address - Phone:214-775-2927
Mailing Address - Fax:214-330-2002
Practice Address - Street 1:5701 W KIEST BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-1047
Practice Address - Country:US
Practice Address - Phone:214-775-2927
Practice Address - Fax:214-330-2002
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant