Provider Demographics
NPI:1902264732
Name:HERLIHY, PAIGE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:
Last Name:HERLIHY
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 1:2800 E BROAD ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6409
Mailing Address - Country:US
Mailing Address - Phone:817-539-0959
Mailing Address - Fax:817-539-0480
Practice Address - Street 1:2800 E BROAD ST
Practice Address - Street 2:SUITE 124
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6409
Practice Address - Country:US
Practice Address - Phone:817-539-0959
Practice Address - Fax:817-539-0480
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant