Provider Demographics
NPI:1609572791
Name:DECELL, NOELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:DECELL
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 1:2051 WITTINGTON PL APT 1191
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1918
Mailing Address - Country:US
Mailing Address - Phone:951-235-6151
Mailing Address - Fax:
Practice Address - Street 1:5941 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-9001
Practice Address - Country:US
Practice Address - Phone:972-758-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16272363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant