Provider Demographics
NPI:1659364222
Name:PURTLE, MICHELLE BYERS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BYERS
Last Name:PURTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8850 SIX PINES DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2683
Mailing Address - Country:US
Mailing Address - Phone:281-364-8844
Mailing Address - Fax:281-364-8833
Practice Address - Street 1:8850 SIX PINES DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2683
Practice Address - Country:US
Practice Address - Phone:281-364-8844
Practice Address - Fax:281-364-8833
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-04338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659364222OtherNPI