Provider Demographics
NPI:1013901339
Name:O'NEAL, DAWN ELISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ELISE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:ELISE
Other - Last Name:GERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 410
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1952
Mailing Address - Country:US
Mailing Address - Phone:903-531-8950
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 410
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1952
Practice Address - Country:US
Practice Address - Phone:903-531-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03230363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319933301Medicaid