Provider Demographics
NPI:1083665855
Name:ALLARD, PAULA LEE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LEE
Last Name:ALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:LEE
Other - Last Name:ALLARD-WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1117 COLINA VISTA LANE
Mailing Address - Street 2:
Mailing Address - City:CROWELY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:817-297-7300
Mailing Address - Fax:
Practice Address - Street 1:12001 SOUTH FREEWAY SUITE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-615-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1774Medicare PIN