Provider Demographics
NPI:1790970747
Name:BHAKTA, AMISHA S (PA)
Entity Type:Individual
Prefix:
First Name:AMISHA
Middle Name:S
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7460 WARREN PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4169
Mailing Address - Country:US
Mailing Address - Phone:972-668-5400
Mailing Address - Fax:972-668-5401
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5401
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2012-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2035487-01Medicaid
TX2933475-01Medicaid
TX2035487-01Medicaid
TXTXB149260Medicare PIN
TX8J9429Medicare PIN