MEDICARE: MRS. TRICIA L WINTERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA03782	TX

General Provider Information

NPI Number	:	1306847587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA L WINTERS PA-C

Provider Business Mailing Address
First Line	:	4513 WILLIAMS DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78633-1302
Country	:	US
Telephone Number	:	512-930-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1464 E WHITESTONE BLVD
Second Line	:	SUITE 301
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9058
Country	:	US
Telephone Number	:	512-260-3376
Fax Number	:	512-260-1177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	03/24/2015

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