Provider Demographics
NPI:1467416248
Name:GAY, CARMEN AMANDA MCCRACKEN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:AMANDA MCCRACKEN
Last Name:GAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W WHITESTONE BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2245
Mailing Address - Country:US
Mailing Address - Phone:512-250-3900
Mailing Address - Fax:512-249-6232
Practice Address - Street 1:500 W WHITESTONE BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2245
Practice Address - Country:US
Practice Address - Phone:512-250-3900
Practice Address - Fax:512-249-6232
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS62464Medicare UPIN