Provider Demographics
NPI:1285812685
Name:VER HALEN, ELAINE EWING (PAC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:EWING
Last Name:VER HALEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:ELAINE
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:7945 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1762
Mailing Address - Country:US
Mailing Address - Phone:713-818-5367
Mailing Address - Fax:901-347-8295
Practice Address - Street 1:7167 COLLEYVILLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8002
Practice Address - Country:US
Practice Address - Phone:817-484-0169
Practice Address - Fax:817-809-7820
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1717363A00000X
TXPA05606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1080640OtherNCCPA
TX8Y3814OtherBCBS
1080640OtherNCCPA