Provider Demographics
NPI:1194560391
Name:MASONHEIMER, OLIVIA (PA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MASONHEIMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1308 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3454
Mailing Address - Country:US
Mailing Address - Phone:678-727-3348
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5251
Practice Address - Country:US
Practice Address - Phone:214-919-2350
Practice Address - Fax:214-919-2361
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA18136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant