Provider Demographics
NPI:1336531805
Name:NOEL, EVONI (PA)
Entity Type:Individual
Prefix:
First Name:EVONI
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N KIMBALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6886
Mailing Address - Country:US
Mailing Address - Phone:817-421-4388
Mailing Address - Fax:817-421-4388
Practice Address - Street 1:630 N KIMBALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6886
Practice Address - Country:US
Practice Address - Phone:817-421-8777
Practice Address - Fax:817-421-4388
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA09637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant