Provider Demographics
NPI:1801811419
Name:DOWNES, AMBER L (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:DOWNES
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 1:1217 OAKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1125
Mailing Address - Country:US
Mailing Address - Phone:817-457-3853
Mailing Address - Fax:817-457-2794
Practice Address - Street 1:1217 OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1125
Practice Address - Country:US
Practice Address - Phone:817-457-3853
Practice Address - Fax:817-457-2794
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182456701Medicaid
TX182456704Medicaid
TXQ51595Medicare UPIN
TX8G1718Medicare ID - Type Unspecified
TXTXB103819Medicare PIN
TX182456704Medicaid
TX182456701Medicaid
TXTXB103839Medicare PIN