Provider Demographics
NPI:1104919190
Name:PIPER, TAMISHA RENEE (PA C)
Entity type:Individual
Prefix:
First Name:TAMISHA
Middle Name:RENEE
Last Name:PIPER
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 1:3801 WILLIAM D TATE AVE STE 840-A
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:214-548-9307
Mailing Address - Fax:817-310-0709
Practice Address - Street 1:3801 WILLIAM D TATE AVE STE 840-A
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:214-808-2975
Practice Address - Fax:817-310-0709
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0140934OtherDPS
P00230864OtherMEDICARE RAILROAD
TXK0140934OtherDPS
TX8L8017Medicare PIN
TX8L8044Medicare PIN
P00230864OtherMEDICARE RAILROAD
TXQ46648Medicare UPIN