Provider Demographics
NPI:1386109064
Name:MEHTA, AVANI MUKESH (PA-C)
Entity type:Individual
Prefix:
First Name:AVANI
Middle Name:MUKESH
Last Name:MEHTA
Suffix:
Gender:F
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 1:10606 PRESCOTT HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8623
Mailing Address - Country:US
Mailing Address - Phone:281-687-0596
Mailing Address - Fax:
Practice Address - Street 1:21700 KINGSLAND BLVD STE 104
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2546
Practice Address - Country:US
Practice Address - Phone:281-829-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant