Provider Demographics
NPI:1922289222
Name:MEHLHAFF, CINDY M (PA)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:M
Last Name:MEHLHAFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:M
Other - Last Name:MEHLHAFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2014 BEN MERRITT DR STE A2
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3851
Mailing Address - Country:US
Mailing Address - Phone:940-626-0052
Mailing Address - Fax:940-626-0082
Practice Address - Street 1:2014 BEN MERRITT DR STE A2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3851
Practice Address - Country:US
Practice Address - Phone:940-626-0052
Practice Address - Fax:940-626-0082
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00495OtherONE USER.,PA