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NPI Code Detail

MEDICARE: MRS. ANGELA M TWILLEY PA-C

MEDICARE: MRS. ANGELA M TWILLEY 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 AssistantPA04776TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21871541607OTHERTXTRICARE SOUTH
38N9868OTHERTXBCBSTX PROV NO.

General Provider Information

NPI Number : 1871541607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA M TWILLEY PA-C
Provider Business Mailing Address
First Line : PO BOX 200993
Second Line :
City : HOUSTON
State : TX
Zip : 77216-0993
Country : US
Telephone Number : 281-784-1111
Fax Number : 281-784-1555
Provider Business Practice Location Address
First Line : 4420 W MAIN ST STE A
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-1737
Country : US
Telephone Number : 832-632-1015
Fax Number : 832-905-5175
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/24/2020

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