Provider Demographics
NPI:1609446467
Name:MANOUN, JANEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JANEEN
Middle Name:
Last Name:MANOUN
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 1:3412 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8941
Mailing Address - Country:US
Mailing Address - Phone:469-230-5840
Mailing Address - Fax:
Practice Address - Street 1:5220 W UNIVERSITY DR STE 250
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7074
Practice Address - Country:US
Practice Address - Phone:469-800-5400
Practice Address - Fax:469-800-5388
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA14429OtherTEXAS STATE MEDICAL BOARD LICENSE