Provider Demographics
NPI:1912259755
Name:PAUL, AMANDA B (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:PAUL
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 1:9925 GILLESPIE DR STE 3400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-7535
Mailing Address - Country:US
Mailing Address - Phone:214-383-0001
Mailing Address - Fax:
Practice Address - Street 1:9925 GILLESPIE DR STE 3400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-7535
Practice Address - Country:US
Practice Address - Phone:214-383-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07274363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical