Provider Demographics
NPI:1396031472
Name:JOSEPH, CHRISTAL DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:DAWN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:DAWN
Other - Last Name:HOWERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6124 W PARKER RD STE 131
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8125
Mailing Address - Country:US
Mailing Address - Phone:972-981-7135
Mailing Address - Fax:972-981-7136
Practice Address - Street 1:221 W COLORADO BLVD STE 525
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2312
Practice Address - Country:US
Practice Address - Phone:214-960-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297932006Medicaid
TX297932004Medicaid
TX297932002Medicaid
TXTXB152188Medicare PIN
TX283862YP79Medicare PIN
TX297932002Medicaid
TX354350YKQLMedicare PIN
TX354350YKP5Medicare PIN