Provider Demographics
NPI:1063788685
Name:PATERSON, RAECHEL PAULINE (PA)
Entity type:Individual
Prefix:
First Name:RAECHEL
Middle Name:PAULINE
Last Name:PATERSON
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 1:18101 PRESTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5473
Mailing Address - Country:US
Mailing Address - Phone:972-584-9444
Mailing Address - Fax:
Practice Address - Street 1:18101 PRESTON RD STE 201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252
Practice Address - Country:US
Practice Address - Phone:972-584-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical