Provider Demographics
NPI:1841756434
Name:PHAM, AILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:AILEY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AI
Other - Middle Name:LE KIEM
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 W ARBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4316
Mailing Address - Country:US
Mailing Address - Phone:817-200-6680
Mailing Address - Fax:817-200-6731
Practice Address - Street 1:800 W ARBROOK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4316
Practice Address - Country:US
Practice Address - Phone:817-200-6680
Practice Address - Fax:817-200-6731
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA12727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant