MEDICARE: KANDACE DENISE GARD-DAWSON P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA04235	TX

General Provider Information

NPI Number	:	1427060144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDACE DENISE GARD-DAWSON P.A.

Provider Business Mailing Address
First Line	:	1901 N US HIGHWAY 87
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-0283
Country	:	US
Telephone Number	:	432-267-8216
Fax Number	:	432-268-7790

Provider Business Practice Location Address
First Line	:	1901 HIGHWAY 87 N
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-0283
Country	:	US
Telephone Number	:	432-267-8216
Fax Number	:	432-268-7790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	06/20/2008

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