Provider Demographics
NPI:1134631716
Name:NASSER, ADEL (PA)
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N LOOP 340
Mailing Address - Street 2:
Mailing Address - City:LACY LAKEVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2400
Mailing Address - Country:US
Mailing Address - Phone:254-870-6500
Mailing Address - Fax:
Practice Address - Street 1:1130 N LOOP 340
Practice Address - Street 2:
Practice Address - City:LACY LAKEVIEW
Practice Address - State:TX
Practice Address - Zip Code:76705-2400
Practice Address - Country:US
Practice Address - Phone:254-870-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPATEMP363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant