Provider Demographics
NPI:1508321878
Name:THOMPSON, DANA SHERMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SHERMAN
Last Name:THOMPSON
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 1:501 PEDEN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1449
Mailing Address - Country:US
Mailing Address - Phone:651-357-6158
Mailing Address - Fax:
Practice Address - Street 1:2350 ATASCOCITA RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3503
Practice Address - Country:US
Practice Address - Phone:651-357-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical