Healthcare Provider Details

I. General information

NPI: 1629484167
Provider Name (Legal Business Name): FIONA K. PATEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 W UNIVERSITY DR STE 100
PROSPER TX
75078-8134
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 469-329-7860
  • Fax:
Mailing address:
  • Phone: 214-424-2213
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: