Healthcare Provider Details

I. General information

NPI: 1922037894
Provider Name (Legal Business Name): ELIZABETH BRADLEY PALAZZETTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E STATE HIGHWAY 114 STE 300
SOUTHLAKE TX
76092-1484
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 500
DALLAS TX
75231-0928
US

V. Phone/Fax

Practice location:
  • Phone: 817-251-6500
  • Fax: 817-442-0050
Mailing address:
  • Phone: 214-987-3376
  • Fax: 469-532-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: