MEDICARE: MADISON ELIZABETH SKELTON 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
1	363A00000X	Physician Assistant	PA14000	TX

General Provider Information

NPI Number	:	1598365611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ELIZABETH SKELTON PA-C

Provider Business Mailing Address
First Line	:	2460 N I 35 STE 165
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-5258
Country	:	US
Telephone Number	:	972-938-3493
Fax Number	:	972-937-5608

Provider Business Practice Location Address
First Line	:	2460 N I 35 STE 165
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-5258
Country	:	US
Telephone Number	:	972-938-3493
Fax Number	:	972-937-5608

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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