Provider Demographics
NPI:1477793495
Name:MATHEW, MINY K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MINY
Middle Name:K
Last Name:MATHEW
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 1:2361 SHOREHAM CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5592
Mailing Address - Country:US
Mailing Address - Phone:972-899-3146
Mailing Address - Fax:
Practice Address - Street 1:4325 N JOSEY LN STE 300
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4638
Practice Address - Country:US
Practice Address - Phone:469-800-4900
Practice Address - Fax:469-800-4909
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04162363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315565701Medicaid
TX8L12739Medicare PIN
TX315565701Medicaid