Provider Demographics
NPI:1093592503
Name:BABU, KEZIAH ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KEZIAH
Middle Name:ELIZABETH
Last Name:BABU
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 1:3517 WINDHAVEN PKWY APT 2508
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6950
Mailing Address - Country:US
Mailing Address - Phone:516-637-3027
Mailing Address - Fax:469-495-0141
Practice Address - Street 1:13024 DALLAS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4240
Practice Address - Country:US
Practice Address - Phone:469-495-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11707207Q00000X
TXPA18170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine