Provider Demographics
NPI:1851309371
Name:PATRICE, CARTY-ANNA (PAC)
Entity type:Individual
Prefix:
First Name:CARTY-ANNA
Middle Name:
Last Name:PATRICE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CARTY-ANNA
Other - Middle Name:
Other - Last Name:PATRICE-MOMOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:12201 MONTWOOD DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2620
Mailing Address - Country:US
Mailing Address - Phone:915-320-7809
Mailing Address - Fax:915-598-3946
Practice Address - Street 1:12201 MONTWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2620
Practice Address - Country:US
Practice Address - Phone:915-320-7809
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04293OtherPA LICENSE