Provider Demographics
NPI:1427486646
Name:PETRASH, PRISCILLA LOUISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:LOUISE
Last Name:PETRASH
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:17110 DALLAS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1167
Mailing Address - Country:US
Mailing Address - Phone:972-380-7000
Mailing Address - Fax:972-380-9266
Practice Address - Street 1:17110 DALLAS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1167
Practice Address - Country:US
Practice Address - Phone:972-380-7000
Practice Address - Fax:972-380-9266
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2021-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08202B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08202OtherTEXAS MEDICAL BOARD
0010-04262OtherNORTH CAROLINA MEDICAL BOARD