Provider Demographics
NPI:1811615495
Name:MCNAIR, MALIA A
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:A
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 SCHRAMM ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0082
Mailing Address - Country:US
Mailing Address - Phone:915-241-6160
Mailing Address - Fax:
Practice Address - Street 1:2010 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6514
Practice Address - Country:US
Practice Address - Phone:817-893-9200
Practice Address - Fax:817-893-9300
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA18477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant