Provider Demographics
NPI:1316384928
Name:ANSEL, STEPHEN K (PA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:K
Last Name:ANSEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3350 US HIGHWAY 90A W
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-6263
Mailing Address - Country:US
Mailing Address - Phone:361-594-3824
Mailing Address - Fax:361-594-4104
Practice Address - Street 1:124 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-7109
Practice Address - Country:US
Practice Address - Phone:361-594-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant