Provider Demographics
NPI:1316323595
Name:ALTERS, JOANNE ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:ELAINE
Last Name:ALTERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:ELAINE
Other - Last Name:MELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1367 DOMINION PLZ
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1013
Mailing Address - Country:US
Mailing Address - Phone:903-534-6200
Mailing Address - Fax:
Practice Address - Street 1:1367 DOMINION PLZ
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1013
Practice Address - Country:US
Practice Address - Phone:904-534-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AS0400X
TXPA10070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348559103Medicaid
TX348559104OtherMEDICAID CSHCN
TX368332801Medicaid