Provider Demographics
NPI:1508505892
Name:MCCOLM, IRIS NADIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:NADIA
Last Name:MCCOLM
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 1:8213 MEADOW RD APT 2404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3838
Mailing Address - Country:US
Mailing Address - Phone:214-995-6179
Mailing Address - Fax:
Practice Address - Street 1:12801 MIDWAY RD STE 503
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6303
Practice Address - Country:US
Practice Address - Phone:972-243-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA15906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant