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NPI Code Detail

MEDICARE: MS. CYNTHIA JEAN TRICKETT PA-C

MEDICARE: MS. CYNTHIA JEAN TRICKETT 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 AssistantPA01467TX

General Provider Information

NPI Number : 1538130216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CYNTHIA JEAN TRICKETT PA-C
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 8144 WALNUT HILL LN STE 1300
Second Line :
City : DALLAS
State : TX
Zip : 75231-4365
Country : US
Telephone Number : 214-420-7070
Fax Number : 214-420-7380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 06/19/2024

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