Healthcare Provider Details

I. General information

NPI: 1518729508
Provider Name (Legal Business Name): MARIAM YAHYA RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 08/29/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 HARRY HINES BLVD
DALLAS TX
75390-2741
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-4673
  • Fax: 214-645-2615
Mailing address:
  • Phone: 214-456-6713
  • Fax: 214-456-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: