Provider Demographics
NPI:1205599826
Name:AVELLANET, ALLAN JOSHUA (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:JOSHUA
Last Name:AVELLANET
Suffix:
Gender:M
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 1:1425 W PETERS COLONY RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2774
Mailing Address - Country:US
Mailing Address - Phone:972-672-8224
Mailing Address - Fax:
Practice Address - Street 1:11350 US HIGHWAY 380 STE 100
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-8319
Practice Address - Country:US
Practice Address - Phone:940-228-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363AS0400X
TXPA15145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical