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NPI Code Detail

MEDICARE: AMBER RENEE MAYES PA-C

MEDICARE: AMBER RENEE MAYES PA-C
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
1363A00000XPhysician AssistantPA06954TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497056071
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER RENEE MAYES PA-C
Provider Business Mailing Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Provider Business Practice Location Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2010
Last Update Date : 04/16/2019

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1770556698 — FAWN MARIE WILLARD FNP
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1386821213 — RYAN P KENDRICK PAC
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76244-4971
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1669736617 — JAMIE L GULLY NP
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1225449788 — MRS. LATHA MATHEW THOMAS RN,FNP
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1487307518 — RAMU GUNDA RPH
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Directions to “ AMBER RENEE MAYES PA-C” Practice Location

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