Provider Demographics
NPI:1942746953
Name:FARUKI, MYRA RAFI (PA-C)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:RAFI
Last Name:FARUKI
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 1:21003 HIGHLAND KNOLLS DRIVE
Mailing Address - Street 2:SUITE 300 (SUITE 103)
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:832-600-1907
Mailing Address - Fax:
Practice Address - Street 1:21003 HIGHLAND KNOLLS DRIVE
Practice Address - Street 2:SUITE 300 (SUITE 103)
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:832-600-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant