Provider Demographics
NPI:1437175163
Name:PAREDES, NANETTE R (PA-C)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:R
Last Name:PAREDES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:R
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-686-6605
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5849
Practice Address - Country:US
Practice Address - Phone:432-684-6962
Practice Address - Fax:432-684-6376
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX716134OtherTX MEDICARE
TXPA04008OtherLICENSE