Provider Demographics
NPI:1568886125
Name:NOBLES, MISTY (PA-C)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:NOBLES
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 1:3401 N CALAIS DR
Mailing Address - Street 2:STE B
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3104
Mailing Address - Country:US
Mailing Address - Phone:903-892-8222
Mailing Address - Fax:903-892-8444
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226-0300
Practice Address - Country:US
Practice Address - Phone:806-874-3531
Practice Address - Fax:806-874-2244
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08530OtherPA-C