Healthcare Provider Details

I. General information

NPI: 1467097105
Provider Name (Legal Business Name): RACHEL ANDERSON MAHMUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL JOAN ANDERSON PA-C

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E INTERSTATE 20
WEATHERFORD TX
76086-6745
US

IV. Provider business mailing address

821 E INTERSTATE 20
WEATHERFORD TX
76086-6745
US

V. Phone/Fax

Practice location:
  • Phone: 817-596-4313
  • Fax:
Mailing address:
  • Phone: 817-596-4313
  • Fax: 817-341-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: