Provider Demographics
NPI:1154567212
Name:MARTIN, ALLISON LEIGH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LEIGH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:KROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3320 OAKWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3128
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:210-829-5030
Practice Address - Street 1:3349 S HIGHWAY 181 STE 6
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-5247
Practice Address - Country:US
Practice Address - Phone:210-829-5180
Practice Address - Fax:210-829-5030
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03525363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03525OtherTEXAS LICENSE
TX217473204Medicaid