Healthcare Provider Details

I. General information

NPI: 1568886125
Provider Name (Legal Business Name): MISTY NOBLES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
CLARENDON TX
79226-0300
US

IV. Provider business mailing address

3401 N CALAIS DR STE B
SHERMAN TX
75090-3104
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-3531
  • Fax: 806-874-2244
Mailing address:
  • Phone: 903-892-8222
  • Fax: 903-892-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number08530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: