Provider Demographics
NPI:1780960518
Name:SPAULDING, PAULA TIU (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:TIU
Last Name:SPAULDING
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 1:2346 INFANTRY POST RD
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-1308
Mailing Address - Country:US
Mailing Address - Phone:082-317-3285
Mailing Address - Fax:
Practice Address - Street 1:8930 FOURWINDS DR STE 101
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1971
Practice Address - Country:US
Practice Address - Phone:210-653-7444
Practice Address - Fax:210-653-7456
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-932363A00000X
TXPA11454363A00000X
AZ5426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ822117Medicaid
AZ822117Medicaid