Healthcare Provider Details

I. General information

NPI: 1407187032
Provider Name (Legal Business Name): FIONA M WYCOFF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 CENTRAL PKWY E SUITE 275
PLANO TX
75074-5561
US

IV. Provider business mailing address

850 CENTRAL PKWY E SUITE 275
PLANO TX
75074-5561
US

V. Phone/Fax

Practice location:
  • Phone: 972-881-4688
  • Fax: 972-881-4609
Mailing address:
  • Phone: 972-881-4688
  • Fax: 972-881-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: