Provider Demographics
NPI:1609152255
Name:EBNER, AMBER HANKS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:HANKS
Last Name:EBNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:LEIGH
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:503 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3235
Mailing Address - Country:US
Mailing Address - Phone:972-937-5252
Mailing Address - Fax:972-937-5259
Practice Address - Street 1:503 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3235
Practice Address - Country:US
Practice Address - Phone:972-937-5252
Practice Address - Fax:972-937-5259
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07466OtherLICENSE