Provider Demographics
NPI:1144708827
Name:MCCALL, MICHELLE THERESA (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESA
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 W INTERSTATE 20 STE 114
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5871
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-804-8178
Practice Address - Street 1:811 W INTERSTATE 20 STE 114
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5871
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-804-8178
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant