Provider Demographics
NPI:1750030987
Name:MAYER, RACHEL ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:MAYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 N. BECKLEY AVE
Mailing Address - Street 2:PAVILION III SUITE 152
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-948-2076
Mailing Address - Fax:214-948-9990
Practice Address - Street 1:1411 N. BECKLEY AVE
Practice Address - Street 2:PAVILION III SUITE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:214-948-9990
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant