Provider Demographics
NPI:1902243777
Name:BARDIN, ALLISON C (PA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:BARDIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WILLIAM D TATE AVE STE 840
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8759
Mailing Address - Country:US
Mailing Address - Phone:817-310-3772
Mailing Address - Fax:817-310-3950
Practice Address - Street 1:3801 WILLIAM D TATE AVE STE 840
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8759
Practice Address - Country:US
Practice Address - Phone:817-310-3772
Practice Address - Fax:817-310-3950
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311011YKPWMedicare PIN