Provider Demographics
NPI:1548297229
Name:PATTISON-THOMAS, TERESA (PA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PATTISON-THOMAS
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 1:1215 S COULTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1769
Mailing Address - Country:US
Mailing Address - Phone:806-350-7307
Mailing Address - Fax:806-677-2024
Practice Address - Street 1:1215 S COULTER ST STE 400
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1769
Practice Address - Country:US
Practice Address - Phone:806-358-8331
Practice Address - Fax:806-677-2024
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339714301Medicaid
TX351423ZGPNMedicare UPIN