Provider Demographics
NPI:1205170156
Name:POSTON, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:POSTON
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 1:2708 JEFFERSON DR STE A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-1036
Mailing Address - Country:US
Mailing Address - Phone:936-334-8800
Mailing Address - Fax:936-334-8801
Practice Address - Street 1:2708 JEFFERSON DR STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-1036
Practice Address - Country:US
Practice Address - Phone:936-334-8800
Practice Address - Fax:936-334-8801
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03872363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMP1174705OtherDEA