Provider Demographics
NPI:1992059158
Name:ADAMS, ABIOLA A (PA)
Entity type:Individual
Prefix:MR
First Name:ABIOLA
Middle Name:A
Last Name:ADAMS
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 1:5108 PECOS RIVER TRL
Mailing Address - Street 2:APT.2115
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1296
Mailing Address - Country:US
Mailing Address - Phone:469-247-5412
Mailing Address - Fax:
Practice Address - Street 1:5108 PECOS RIVER TRL
Practice Address - Street 2:APT.2115
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1296
Practice Address - Country:US
Practice Address - Phone:469-247-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08325363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315211802Medicaid
TX315211801Medicaid
TX272270YLLYMedicare PIN
TX315211801Medicaid