Provider Demographics
NPI:1720791866
Name:PEWITT, AUSTYN MATTHEW (PA)
Entity type:Individual
Prefix:
First Name:AUSTYN
Middle Name:MATTHEW
Last Name:PEWITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 HARRIS PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4261
Mailing Address - Country:US
Mailing Address - Phone:817-916-4685
Mailing Address - Fax:817-769-3718
Practice Address - Street 1:6900 HARRIS PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4261
Practice Address - Country:US
Practice Address - Phone:817-916-4685
Practice Address - Fax:817-769-3718
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant