Healthcare Provider Details

I. General information

NPI: 1053152124
Provider Name (Legal Business Name): AVERY ELIZABETH NORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 COMMUNICATIONS PKWY
PLANO TX
75024-5991
US

IV. Provider business mailing address

3033 ROUTH ST APT 503
DALLAS TX
75201-5261
US

V. Phone/Fax

Practice location:
  • Phone: 469-379-8222
  • Fax:
Mailing address:
  • Phone: 337-781-9469
  • Fax:

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 NumberPA18399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: