Provider Demographics
NPI:1972945145
Name:GENTRY, ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GENTRY
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 1:929 GRAHAM DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6451
Mailing Address - Country:US
Mailing Address - Phone:281-351-5548
Mailing Address - Fax:281-351-5020
Practice Address - Street 1:929 GRAHAM DR
Practice Address - Street 2:SUITE B
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6451
Practice Address - Country:US
Practice Address - Phone:281-351-5548
Practice Address - Fax:281-351-5020
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08491OtherSTATE