Provider Demographics
NPI:1407187032
Name:WYCOFF, FIONA M (PA)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:M
Last Name:WYCOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CENTRAL PKWY E
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5561
Mailing Address - Country:US
Mailing Address - Phone:972-881-4688
Mailing Address - Fax:972-881-4609
Practice Address - Street 1:850 CENTRAL PKWY E
Practice Address - Street 2:SUITE 275
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5561
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:972-881-4609
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N0136OtherBCBS
TXP01054027OtherRAILROAD PTAN
TXTXB150919Medicare PIN
TXP01054027OtherRAILROAD PTAN