Provider Demographics
NPI:1881688471
Name:VAN ARK, JURRY E (PA-C)
Entity Type:Individual
Prefix:
First Name:JURRY
Middle Name:E
Last Name:VAN ARK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 DEERLAKE CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5057
Mailing Address - Country:US
Mailing Address - Phone:760-382-0827
Mailing Address - Fax:
Practice Address - Street 1:231 SOUTH COLLINS
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4624
Practice Address - Country:US
Practice Address - Phone:877-485-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04200363A00000X, 363AM0700X
CAPA17380363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216379203Medicaid
TXP01233936OtherRAILROAD MCARE
TX8Y1192OtherBLUE CROSS BLUE SHIELD
CAOPA173800OtherBLUE SHIELD
TX216379201Medicaid
TX216379204Medicaid
TX216379202Medicaid
CAPA17380Medicaid
TXTXB131869Medicare PIN
TX8Y1192OtherBLUE CROSS BLUE SHIELD
TX216379203Medicaid
TXTXB109743Medicare PIN
TX216379201Medicaid