Provider Demographics
NPI:1194048124
Name:MISTRY, JIGNESH P (PA-C)
Entity type:Individual
Prefix:
First Name:JIGNESH
Middle Name:P
Last Name:MISTRY
Suffix:
Gender:M
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 1:2500 DALLAS PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4876
Mailing Address - Country:US
Mailing Address - Phone:817-360-1791
Mailing Address - Fax:
Practice Address - Street 1:2500 DALLAS PKWY STE 111
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4876
Practice Address - Country:US
Practice Address - Phone:817-360-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical