Provider Demographics
NPI:1811067374
Name:VALLES, ANNA (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VALLES
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 1:1350 S MAIN ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7669
Mailing Address - Country:US
Mailing Address - Phone:817-702-8400
Mailing Address - Fax:
Practice Address - Street 1:1741 E BARDIN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-4836
Practice Address - Country:US
Practice Address - Phone:817-702-8700
Practice Address - Fax:817-702-4243
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant