Provider Demographics
NPI:1144624479
Name:MATHEW, ANITHA (PA-C)
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 SNIDER PLZ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1330
Mailing Address - Country:US
Mailing Address - Phone:469-868-6005
Mailing Address - Fax:
Practice Address - Street 1:6825 SNIDER PLZ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1330
Practice Address - Country:US
Practice Address - Phone:469-868-6005
Practice Address - Fax:469-868-6120
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09287363A00000X
TX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant