MEDICARE: ELIZABETH AMANDA GARRETT 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	363A00000X	Physician Assistant	PA.200620	LA
2	363A00000X	Physician Assistant	PA09843	TX

General Provider Information

NPI Number	:	1417395351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH AMANDA GARRETT PA-C

Provider Business Mailing Address
First Line	:	19200 PRESTON RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-2450
Country	:	US
Telephone Number	:	469-200-2832
Fax Number	:	469-269-1074

Provider Business Practice Location Address
First Line	:	19200 PRESTON RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-2450
Country	:	US
Telephone Number	:	469-200-2832
Fax Number	:	469-269-1074

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

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	05/05/2020

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