Provider Demographics
NPI:1679906168
Name:RANSOM, DEANDRA
Entity Type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANDRA
Other - Middle Name:
Other - Last Name:CERDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3320 OAKWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3128
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:210-829-5030
Practice Address - Street 1:3327 RESEARCH PLZ STE 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5157
Practice Address - Country:US
Practice Address - Phone:210-829-5180
Practice Address - Fax:210-829-5030
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3215774-01Medicaid