Healthcare Provider Details

I. General information

NPI: 1487052767
Provider Name (Legal Business Name): TRICIA STUART PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 BILL PRICE RD
DEL VALLE TX
78617-3630
US

IV. Provider business mailing address

3614 BILL PRICE RD
DEL VALLE TX
78617-3630
US

V. Phone/Fax

Practice location:
  • Phone: 512-854-4193
  • Fax: 512-254-4665
Mailing address:
  • Phone: 512-854-4193
  • Fax: 512-254-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA09304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: