Healthcare Provider Details

I. General information

NPI: 1407081920
Provider Name (Legal Business Name): KARISHMA PRAVIN PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 MESA DR
DENTON TX
76207-3460
US

IV. Provider business mailing address

4310 MESA DR
DENTON TX
76207-3460
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-5788
  • Fax: 940-381-6242
Mailing address:
  • Phone: 940-387-5788
  • Fax: 940-381-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06160
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: