Provider Demographics
NPI:1902841919
Name:RAND, THERESA E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:E
Last Name:RAND
Suffix:
Gender:F
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: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 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-8679
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002369A363AS0400X
TXPA00448363A00000X
WYTL469363A00000X
FLPA2364363A00000X
VA0110004634363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217157101Medicaid
VA1902841919OtherNPI
MO196968OtherANTHEM
TXP01078448OtherRR MEDICARE
TX217157102Medicaid
TX1902841919OtherBLUE CROSS BLUE SHIELD
VA0110004634OtherLICENCE
OK200043740AMedicaid
KS200301770AMedicaid
P00175628OtherRR MEDICARE
OK200043740AMedicaid
TXP01078448OtherRR MEDICARE
P00175628OtherRR MEDICARE
VA0110004634OtherLICENCE
TX1902841919OtherBLUE CROSS BLUE SHIELD
FLDH252ZMedicare PIN