Provider Demographics
NPI:1013087956
Name:HITCHCOCK, JOHN P (PAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:PAUL
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:BRACKETTVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78832
Mailing Address - Country:US
Mailing Address - Phone:830-563-2434
Mailing Address - Fax:855-729-6740
Practice Address - Street 1:202 JAMES STREET
Practice Address - Street 2:
Practice Address - City:BRACKETTVILLE
Practice Address - State:TX
Practice Address - Zip Code:78832-0729
Practice Address - Country:US
Practice Address - Phone:830-563-2434
Practice Address - Fax:855-729-6740
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3448771-03Medicaid
TX1031098OtherNATIONAL COMMISSION CERTIFICATION PHY.ASSISTANTS