Provider Demographics
NPI:1710369509
Name:ADAMS, MICAH D (PA-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:510 N HEWITT DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3038
Practice Address - Country:US
Practice Address - Phone:254-420-5000
Practice Address - Fax:254-420-5007
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA14235363A00000X
CA52596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant