Provider Demographics
NPI:1710531900
Name:MCGUIRE, SERRA (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:SERRA
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:SERRA
Other - Middle Name:
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1604 HOSPITAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6930
Mailing Address - Country:US
Mailing Address - Phone:817-848-4485
Mailing Address - Fax:
Practice Address - Street 1:1604 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6930
Practice Address - Country:US
Practice Address - Phone:817-848-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant